Two Recent Studies on Pertussis

Source: U.S. Centers for Disease Control and Prevention

Over the past couple of years, and especially this year, there has been an increasing number of news articles about pertussis outbreaks across the United States. In 1976, we had a low of only 1,010 reported cases. Cases reports gradually increased over the 1980s and 1990s, reaching nearly 10,000 by the early 2000s. Then in 2012, there were 48,277 reported cases. As of December 14, 2013, there have been 23,009 cases reported for the year. With the recent uptick in whooping cough across the country, the big question is, unsurprisingly, why? What's causing it? There have been a wide variety of potential explanations: reduced or waning efficacy of the vaccine, declines in vaccine uptake, and changes in the pertussis bacterium itself. Several studies published this year may shed a little light on the issue, especially in terms of vaccine efficacy.

The question of vaccine refusal and its link to outbreaks is not particularly surprising. Published in the journal Pediatrics in October, "Nonmedical vaccine exemptions and pertussis in California, 2010", by Atwell, et al., showed that non-medical exemptions were one of several factors contributing to the 2010 outbreak of whooping cough in California, which claimed the lives of 10 infants. This finding is in line with previous research on the impact of non-vaccination on the risk of outbreaks (see, e.g., here, here, here, and here). Lack of vaccination increases the risk of infection for both the individual and the surrounding members of their community.

Likewise, we know that the immunity from the pertussis vaccine wanes with time, just like the immunity from infection itself. That's nothing new. But two pieces of the puzzle that popped up in the scientific literature recently might explain why efficacy seems to be declining faster than previously thought.

Rob Schneider's Hellish Nonsense

Thursday night, I mentioned that Rob Schneider was going to be on Salt Lake City's KXRK morning radio show Radio From Hell to promote his stand-up show Friday night at Wiseguys West Valley City. I joined Skepchick's Elyse Anders in urging people to contact the station if they had a call-in segment during the interview. Orac also put the word out about this appearance.

Well, I was fortunate enough to find time to listen to the show Friday morning via their internet live stream. As noted by Elyse, Schneider had been on the show before, shamelessly spouting a bunch of tired, well-worn anti-vaccine lies and myths. This morning, he was a bit late showing up at the studio, which I don't blame him for; it was early, he mentioned he only had about 3 hours sleep, and we don't know what his travel and traffic situation was.  The hosts, led by Bill Allred, pondered whether they should just rerun the clip (mp3 hosted at Skepchick) from the last time he was on.

At any rate, he finally showed up to sit down for a chat...

Wanted: Bordetella pertussis

Image from the Public Health Image Library. Logo design by Maggie McFee. More VPD Wanted Poster details here. If you are interested in a print version (16"x20" poster or 4"x5" card), please email me for more information.

NSW Extends Free Pertussis Vaccine for New Mothers

About a month ago, Phil Plait wrote about the Victoria, Australia, Ministry of Health's decision to end a program that provides pertussis vaccine boosters for free to carers of newborns in an effort to protect infants from what can be, for them, a deadly disease. The reason cited was that the program did not "get the clinical result required". This move by the state of Victoria led Toni McCaffery, whose infant daughter, Dana, was killed by pertussis, to create a petition to the Premiers and Health Ministers of Australia to ask the states to continue to provide free pertussis vaccines to adults caring for newborns to help cocoon these infants until they are old enough to be vaccinated.

Well, the state of New South Wales has listened, to a degree.

In Memoriam - U.S. Pertussis Deaths Through May 2012

Catherina over at Just the Vax gave us all a reminder of the real impact of pertussis, or whooping cough. In that vein, this post is in tribute to those who have lost their lives to pertussis this year. My heart goes out to all of these families. Please go out and get your boosters and learn what to look for.

In Memoriam

Brady Alcaide
Age 2 months
Massachusetts

Name Unknown
Age 2 months
Arizona

Francesca Marie McNally
Age 3 months
Michigan

Ariel Renee Esther Salazar
Age 10 1/2 weeks
New Mexico

Kenadee Elizabeth Wilde
Age 9 weeks
Idaho

Name Unknown
Age 1 month
Texas

Name Unknown
Age 1 month
Wisconsin

It's Just a Cold

The other day I shared a little bit of insight into how my brain works at times. Subject associations lead from one thing to another, and before you know it, what began as a relatively mundane musing has taken on cosmic proportions. I certainly never thought that, waking up with the beginnings of a cold, I would end up writing about how a lack of gravity would affect medical care in space.

At any rate, the common cold has been bounding about my head (both as a topic and somewhat more literally). While I've been fortunate in that I've only really had to deal with a stuffy nose and only a minor cough, some of my coworkers have been less fortunate. Some manner of respiratory illness has been making the rounds, resulting in some of my workmates having been home for a day or two, both before I got my cold, and after. Talking to them, some actually brought up the subject of pertussis, or whooping cough. No one really knew much about it or what the symptoms were, but it's been in the news a bit lately, with a current epidemic in Washington state (1,484 cases reported as of May 12 [PDF], 2012, compared to 965 cases in all of 2011 and 608 for all of 2010), as well as smaller outbreaks in other states like Montana (142 cases), Idaho (31 cases, including 1 death), Iowa (150 cases), Wisconsin (~1,900 cases, including 1 death), Maine (55 cases [PDF]), Florida (112 cases [PDF]) and others.

Washington pertussis cases through May 12, 2012

I figured it might be a good idea, then, to pull some stuff together about the differences between a cold and whooping cough.

Vermont Steps Toward Improved Public Health

Vaccination requirements for entry to day care programs and schools tend to be a bit of a touchy subject among those who, for one reason or another, are opposed to immunization. They tend to view such requirements as violations of their personal rights, all the while ignoring the rights of their own children, to say nothing of the rights of the other people around them, to not be infected with diseases that can be quite serious. As I recently wrote, the state of Alaska Section on Epidemiology came out with several recommendations following a chicken pox outbreak at a day care facility, which started after an unimmunized child infected their infant sibling who attended the day care. In my post, I suggested that the recommendations did not quite go far enough, arguing that philosophical or religious exemptions should require speaking to a physician before being granted. Personally, I don't think that there should be exemptions for anything other than legitimate medical reasons, but that's a topic for another post. In the meantime, requiring discussion with a medical professional seems, to me, to be a reasonable compromise for the time being.

The issue of philosophical exemptions came up last summer, as the Massachusetts state legislature considered a proposal to add philosophical exemptions to that state's immunization laws. It's a proposal that pops up just about every year in Massachusetts and is consistently, and, in my opinion, correctly shot down. Well, it looks like the state's neighbor to the north, Vermont, is considering making its laws similar to those of Massachusetts. A bill was recently passed by the Vermont state Senate, in a vote of 25-4, to remove philosophical objections as a reason to forego immunization, leaving only medical and religious exemptions. As the bill goes to the House for consideration, there is, not surprisingly, a vocal few who see the legislation as a Bad Thing^TM.

Take, for example, Charlotte Gilruth, who wrote in to the Barre-Montpelier Times Argus with her opinion in a letter titled "'Herd immunity' is misleading". From the second sentence, her letter is a treasure trove of errors and misinformation. Before I delve into it, go ahead and click on her name above to read her thoughts. See how many mistakes you can find.

Pertussis Toxin, Aiding and Abetting Influenza

Pertussis, or whooping cough, is bad. In infants, it can kill or lead to neurological impairment or other permanent injuries. In adults, the 100-day cough can range from a persistent annoyance to bone-wracking agony. As bacteria go, it's a pretty nasty one. Less than two years ago, an outbreak in California resulted in the deaths of 10 babies. In the mid- to late-1970s, vaccination rates plummeted in many countries after reports of neurological damage following immunization, leaving the immunocompromised at much greater risk. The reports were ultimately mistaken. We are currently seeing another downward trend in vaccine uptake rates, as well as reminders that immunity wanes with time. Outbreaks continue to spread across the United States and other nations as teens and adults fail to get timely boosters and parents opt out of immunizing their children.

Avoiding the agony and loss of time, not to mention possible heartache, that accompanies whooping cough would seem to be a good idea regardless of any other factors. But a new study published in PLoS One hints at another reason to immunize.

A Lesson from History

There are many reasons people are opposed to vaccines. They may have some fear of needles, oppose them for ideological or political reasons, confused a coincidental change in health with a vaccine reaction or simply read and believed propaganda put out by anti-vaccine organizations like the National Vaccine Information Center, Age of Autism, SANEVax and so on. Whatever the reasons for their dislike of vaccines, a frequent question that they ask is, "If your kid is vaccinated, then what does it matter whether or not my kid gets his shots? If vaccines work, then you shouldn't have anything to worry about."

This is a very naive and simplistic question. I addressed this question a while ago and reposted it recently. After presenting some numbers showing what happens when people refuse immunizations, I briefly talked about some people from my own life who could be negatively affected, as well as some hypothetical talk about others that could be harmed.

Recently, a comment at Respectful Insolence brought up a story that I felt should be presented more fully. This is a story of a parent whose child could not be vaccinated and how declines in immunization rates affected the family. Due to the harassing nature of some anti-vaccine activists, identifying details have been altered.

Disappointing Coverage of Pertussis Vaccine Findings

Pertussis has been in the news a fair bit recently. Actually, it's the vaccine against pertussis that has garnered a lot of attention after a recent presentation and study from the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy. The presentation, Marked Acellular Pertussis Vaccine Failure in 8-14 Year-olds in a North American Outbreak, suggests that immunity from the pertussis vaccine can wane in as little as 3 years, covered a study by Kaiser Permanente Medical Center under the supervision of Dr. David Witt.

The story has been picked up by a lot of media outlets, such as the Associated Press and subsequently regurgitated in places like ABC News, The Boston Globe and The San Francisco Chronicle. While the story raises some valid questions, there are some problems with how it is being presented.

A Bill Goes to Beacon Hill

It recently came to my attention that there is a new bill being considered by the state legislature of Massachusetts. It was submitted by petition back in January and does not really have an actual sponsor, though Rep. John Keenan (Salem) is listed. This bill, amending an existing law, would add just one little sentence which would render said law essentially meaningless. Furthermore, the consequences of this one, seemingly innocuous, sentence would be far-reaching in their impact. What is this one little sentence? It is this:

Notwithstanding the provisions of this section a child shall, upon written request of a parent to the school, be admitted to school.

That doesn't sound too bad, right? I mean, parents should be able to write to a school and have their child admitted. After all, the education of children is not only a requirement, but is something that benefits everyone. Everyone should have the opportunity to obtain a good education, to learn valuable skills and expand their knowledge so that they can become useful, contributing members of society for the good of themselves and the community in which they live.

Why would anyone object to that? Certainly I wouldn't, in and of itself. However, as Tim Minchin shows, context is everything (some NSFW language, be sure to watch to the end):

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The Callous Face of Hubris

The video below has already been shared at Just the Vax and Respectful Insolence, but it is such a powerful and important message that I feel it should be shared as broadly as possible.



I don't think we have anyone quite as vile and despicable as Ms. Viera Scheibner in the U.S. At least, I hope not. This is someone who blames the parents if their child dies of a vaccine-preventable disease; someone who believes that all vaccines, without question, are bad and cause autism, and that diseases are, without exception, good. To anyone who is against vaccinations, watch this video and take a good hard look at your beliefs and the impact that they can have on those around you.