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Well Beyond Medicine

No Shot, No School? No Way!

Many parents in California are confused by warnings from schools and public health authorities about new whooping cough vaccination requirements for students entering grades seven through twelve this year. Is this a new vaccine? Isn’t my child already up to date? Does my child need a new booster shot? Can my child be exempted from the whooping cough vaccine for health or other reasons?

California Assembly Bill 354 became law in September of 2010. The new law simply added a whooping cough booster shot to the list of vaccinations recommended for school entry. In spite of strongly worded school announcements and public health advisories giving the impression that this particular shot is absolutely mandatory, as of this writing, the right of parents to refuse this or any other vaccine in California has been preserved.

According to the language in the new law, the California legislature will continue to “provide exemptions from immunization for medical reasons or because of personal beliefs.” But why would a parent want to exempt their child in the first place?

First, some background. The new bill was enacted following a declared epidemic of whooping cough (pertussis) in the state of California in 2010. The most recent epidemic of whooping cough was declared in 2005. The immediate course of action promoted by state and federal public health authorities was more booster shots against pertussis. Many public health authorities incorrectly blamed the epidemic on parents who opt out of vaccinating their kids, apparently forgetting that the percentage of children receiving the vaccine has steadily increased for decades.

“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,” the Centers for Disease Control (CDC) reported ten years ago. The CDC now reports that the number of babies under six months old who contract pertussis has continued to dramatically increase in the United States in the intervening years.

“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,” according to the New York Times in August 2010.

If more babies, kids, and adults than ever before are getting vaccinated against whooping cough, why are we seeing epidemics every few years? And why do fully vaccinated children and adults keep getting the whooping cough?

One explanation given is that vaccine effectiveness wanes over time. This is the rationale for additional shots and boosters periodically being added to the list of recommended vaccines, as well as recommendations to vaccinate and revaccinate older and older populations.

Another explanation is that we are seeing outbreaks of a different pertussis bacteria called parapertussis, with symptoms that are nearly identical. 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.

Even settling on a common definition of pertussis infection has been problematic for public health authorities. An expert committee with the World Health Organization proposed a definition that “required 21 days of paroxysmal cough plus laboratory confirmation of pertussis in the subject or household contact,” according to the journal Pediatrics in December 1999. “There are 2 problems with this definition,” wrote the authors. “The first is that a substantial number of B pertussis infections in unvaccinated children are mild and would not meet the case definition. The second is that all pertussis vaccines tend to modify duration and severity of disease rather than completely preventing illness.

So, a substantial number of pertussis infections in unvaccinated children are mild? What else do we know about whooping cough infections in unvaccinated children? A study of a large number of unvaccinated children with laboratory-confirmed pertussis was published in Pediatrics in December 1997. “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,” wrote the authors.

Widespread use of the pertussis vaccination is reportedly changing the natural age at which whooping cough infections occur in our society. This coincides with CDC reports that adults increasingly suffer whooping cough infections, even as babies today are being infected at a younger age, an age during which they are most vulnerable.

Contrary to most media accounts and public health announcements, the pertussis vaccine is incapable of preventing the spread of whooping cough. The CDC admits this 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.”

The newer, acellular pertussis vaccines are even less effective than the older whole-cell vaccine referred to above, which had to be replaced because a substantial number of children were experiencing serious adverse neurological reactions to it.

Does giving the shot to babies prevent the spread of pertussis infection in that population? Apparently the answer is no. “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 Journal of Clinical Investigation in December 2005.

How about adverse reactions to the newer acellular pertussis vaccines? The CDC tells us that one in 14,000 children receiving the acellular pertussis vaccine will suffer a seizure, one in every 1,000 will have nonstop crying for three hours or more, and one child in 16,000 will spike a fever of more than 105 degrees. Let’s see, about 4 million babies are born each year, and each baby is recommended to receive pertussis injections at 2 months, 4 months, and 6 months of age—that’s three pertussis shots in the first six months of life. Using the CDC’s numbers, the pertussis shot is expected to cause 857 babies per year to have a seizure, about 12,000 to cry nonstop for three hours or more, and 750 to develop a high fever greater than 105 degrees.

How about giving the shot to the rest of the population, does that protect babies? “It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants,” according to the makers of Adacel, a pertussis booster vaccine.

Let’s review what we know about whooping cough and the vaccine. Death from a bout of whooping cough is rare, and a well-nourished child typically comes through whooping cough just fine and ends up with lifetime immunity. Infants are the population most at risk of death from pertussis infection, and the infants that died in California in 2010 were too young to receive the vaccine. The pertussis vaccine does not prevent infection, but only modifies the symptoms. The vaccine is not capable of preventing transmission of pertussis infection to others, and previously vaccinated adults and adolescents are the primary source of the spread of pertussis. Many people who are fully vaccinated get full-blown cases of whooping cough. Outbreaks are on the rise even as vaccination coverage has climbed and remained high. Finally, widespread vaccination against pertussis has resulted in infants contracting whooping cough at a younger age, and increased the ages at which adolescents and adults are becoming infected. To call whooping cough a “vaccine-preventable disease” is grossly inaccurate, based on sixty years of real-world outcomes.

“The definition of insanity is doing the same thing over and over again and expecting different results,” said Albert Einstein. Far be it for me to suggest that our public health leaders are insane on the whooping cough issue. I’m just saying that doing more of the same thing we’ve been doing for more than sixty years and expecting the results to suddenly match the wishful thinking of our health leaders is ludicrous and entirely disconnected from evidence-based public health policy.

In California we parents retain the right to refuse vaccines for our children, and parents are to be commended for educating before vaccinating. Interestingly, there seems to be an inverse relationship between parents’ education level and vaccination, according to the American Journal of Public Health in February 2007. In other words, parents with the highest levels of education consent to the fewest vaccines for their children.

The American Medical Association and the American Academy of Pediatrics are working hard to force a one-size-fits-all vaccine schedule on all children in the United States. Both organizations believe that parents should not have the right to refuse any vaccine whatsoever, and they are working actively in states across the country to try and take away our medical freedom to do so.

I join Barbara Loe Fisher of the National Vaccine Information Center in saying “Show us the science and give us a choice. No forced vaccination. Not in America.”

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