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Whooping Cough In The Vaccinated

Whooping Cough Increases 49% Since 1980’s In The Vaccinated Despite Increasing Number Of Shots

Reported cases of pertussis among adolescents and adults have increased since the 1980s, despite increasingly high rates of vaccination among infants and children. However, severe pertussis morbidity and mortality occur primarily among infants.

The incidence of reported cases of pertussis among infants increased 49% in the 1990s compared with the incidence in the 1980s (19 798 vs 12 550 cases reported; 51.1 cases vs 34.2 cases per 100 000 infant population, respectively). Increases in the incidence of cases and the number of deaths among infants during the 1990s primarily were among those aged 4 months or younger, contrasting with a stable incidence of cases among infants aged 5 months or older. The proportion of cases confirmed by bacterial culture was higher in the 1990s than in the 1980s (50% and 33%, respectively); the proportion of hospitalized cases was unchanged (67% vs 68%, respectively). Receipt of fewer doses of vaccine was associated with hospitalization, when cases were stratified by age in months.

(JAMA. 2003;290:2968-2975).

Despite High Vaccination Coverage Whooping Cough Is Endemic In The Netherlands

Despite the introduction of large-scale pertussis vaccination in 1953 and high vaccination coverage, pertussis is still an endemic disease in The Netherlands, with epidemic outbreaks occurring every 3-5 years.” One factor that might contribute to this is the ability of pertussis strains to adapt to vaccine-induced immunity, causing new strains of pertussis to re-emerge in this well-vaccinated population.

(Journal of Infectious Diseases, vol. 179, April 1999; 915-923).

One in Five Vaccinated Children Will Still Get Whooping Cough

Just recently, Dr. Kari Simonsen, a pediatrician at the University of Nebraska Medical Center, USA, said one in five children who are vaccinated for whooping cough will still get the disease. She said efficacy of the vaccine was ‘comparatively low’, but said
‘It’s the best vaccine we can build to date.’
Despite admitting this, she still believes that parents should get the vaccine for their children.

At St. Robert Bellarmine School in west Omaha, 12 children had confirmed whooping cough, of those, most had been vaccinated.

The Nebraska Department of Health and Human Services reported Thursday that the state has had 117 confirmed cases this year, up from 70 all of last year and 99 in 2006. There were 312 cases in Nebraska in 2005.

In Douglas County, 48 cases have been reported this year. Last year, 21 cases were reported.

This is in a country that gives five doses of the vaccine in the first four years of life and then another dose at 11 years of age!

(Omaha World Herald, ‘Vaccine Didn’t Stop Whooping Cough’, 31st October 2008).

Recently Vaccinated People Are Becoming Sick Anyway And Can Pass The Bacteria On To Others And Make Them Sick

Victor Plotkin – an epidemiologist from Lake County in the US has reported that there have been 82 cases of pertussis in the county so far this year.

‘Plotkin said the county did see very high numbers of cases during a nationwide outbreak of pertussis in 2004 and 2005. In 2004, there were 152 cases of pertussis and 135 cases in 2005. However, before that, pertussis cases in the county had averaged about 8 to 10 a year for many years.

Plotkin said the 2004 and 2005 pertussis outbreak appears that it may have been attributed to waning immunity among older children and adults who had not received booster shots. He said the most recent outbreak is a bit more puzzling because many of the children who are becoming ill are younger children who were recently vaccinated.

“Unfortunately, during this outbreak, even people that have been recently vaccinated are becoming sick anyway,” he said. “Their symptoms are milder, but they still can pass the bacteria along to others and make others sick.”

(Whooping Cough Increases in Lake County – the Vernon Hills Review 20th November 2008).

No Protection Is Demonstrable In Infants Following DPT

‘Calculations based on the mortality of whooping-cough before 1957 predict accurately the subsequent decline and the present low mortality… Incidence [is] unaffected either by small-scale vaccination beginning about 1948 or by nationwide vaccination beginning in 1957… No protection is demonstrable in infants.’

(The Lancet, vol. 1, January 29, 1977, pp. 234-7).

Whooping Cough Rise Despite 90% Vaccination Rate

TASMANIA is in the grip of the worst outbreak of whooping cough for at least a decade.

The Public and Environmental Health Service has been notified of 146 cases of the disease, which is potentially fatal, particularly for babies and young children.

Parents who have not had their children immunised have been advised to act immediately.

The outbreak, concentrated in the South of the state, represents more than double the number of cases for the whole of last year (56).

Director of Public Health Mark Jacobs said: “Most of the cases have occurred in July and August. The August notifications exceeded the total for last year.”

There have been 122 reported cases in the South, 16 in the North and eight in the North-West.

‘Our most recent figures show that about 90% of children are immunised by the time they reach their first birthday,” Dr Jacobs said.

9th September 1999 – The Mercury. Written by Sean Stevenson.

Whooping Cough Confirmed – All Of The Kids Were ‘Up To Date’ On Their DTAP Vaccinations

The San Juan Basin Health Department has reported four more individuals have been confirmed as having pertussis (whooping cough) and two more cases are considered probable. These new cases are scattered throughout the county, including one case in a Bayfield preschool.

Nearly half of the cases diagnosed have occurred in the four-six year old age group. All of these kids are “up to date” on Dtap vaccination but had not yet received the kindergarten dose. If your child is nearing age 15 months of age or 4 years of age and has not had their booster dose of Dtap, we recommend vaccinating them as soon as possible because the protection from DtaP vaccine diminishes over time.

Source: Pine River Times, 23rd January 2009.

VAN UK’s Comment: Children in the US get 4 doses of DTAP vaccine between the ages of 2 months and 18 months and another dose at 4 years old. The kid would have had their last vaccine only two or three years before and it still didn’t work?

13 Cases Of Whooping Cough In January In Kalamazoo

“We definitely have an outbreak going on,” said Buzas, “we’ve had 35 cases between September and the end of December.”

In fact, cases of pertussis have been steadily increasing for several years, and although there are some vague theories, no one is sure why.

“What we’re seeing though is children who are immunized, completely immunized, are getting pertussis,” said Buzas.

Source: WWMT.com news channel, 29 January 2009.

21 Cases Of Whooping Cough, All Were Vaccinated As Vaccine Wanes At Age 7 To 9

As of this afternoon, the health department had 21 confirmed cases of whooping cough, known formally as pertussis. There also were five probable cases of the contagious disease, and a half-dozen possible cases are under investigation.

Of the first dozen cases of pertussis, 10 were children at the Clinton Public School and another was a child who came into contact with someone from the Clinton school.

The infected children had been vaccinated, but the immunity to the vaccine can wane between ages 7 and 9 and there is no licensed vaccine for children in that age group.

Source: The Star Ledger, 11 February 2009, by Mike Frassinelli.

Whooping Cough In Suffolk County, US. Those Affected Were Vaccinated

The county health commissioner says whooping cough is highly contagious and symptoms can develop anywhere from 3 days to 3 weeks, so parents need to be especially vigilant to help stop this from spreading countywide.

The warning comes after two students in the district have been diagnosed with the potentially fatal bacterial infection. The health department would only say they are elementary aged students and were being treated.

Chaudry said both students who contracted whooping cough had been immunized.

He suggested parents call their pediatricians about booster shots since it appears the vaccination is waning for an unknown reason. There are 70 to 80 cases every year in Suffolk County.

Source: WABC-TV, New York, 13 March 2009.

Whooping Cough Vaccine Not Working And New Strain Of Whooping Cough Emerging

Pertussis (whooping cough) is a potentially fatal respiratory disease caused by the bacterium Bordetella pertussis. Despite effective vaccination programs, there has been concern in some developed countries that pertussis cases are on the increase.,….. This supports a hypothesis that MLVA-27 is under some form of positive selection conferring increased survival in a highly vaccinated population.

Source: Journal of Clinical Microbiology, March 2009, p. 680-688, Vol. 47, No. 3.

In Whooping Cough Epidemic, 17 out of 18 Cases Had Had FIVE Doses Of DTaP!

A cluster of whooping cough cases among Cobb County elementary students is adding to concerns that an important vaccine isn’t as effective as it needs to be to stop the spread of disease.

Of the 18 students in the recent Cobb cluster, 17 were properly immunized with five doses of DTaP vaccine, which protects against diphtheria, tetanus and pertussis, health officials said.

“Despite the fact that we routinely vaccinate against pertussis, pertussis is endemic. There’s lots of pertussis,” said Dr. Nancy Messonnier, director of CDC’s meningitis and vaccine preventable diseases branch.

East Cobb parent Laurie Wood assumed her children were protected because they’d received all the shots. Then her 8-year-old son, Charlie, developed a cough so severe it caused him to vomit. In January, Charlie was diagnosed with pertussis.

“I was scared because he’s been vaccinated,” Wood said last week. “I also was mad because if the vaccination wasn’t working, we should have known about it.”

To try to determine the magnitude of the problem at the four Cobb schools, last month CDC and local health officials gave voluntary pertussis tests to 108 children and staff who were currently coughing, and 22 of them showed evidence of recent infection, said Julie Gabel, a state health department epidemiologist.

Despite the study’s test results, some doctors refused to believe parents when they said that their children had pertussis. “More than one said to the parent: ‘Well, your child couldn’t have had pertussis, your child’s been vaccinated,” Gabel said, adding that the department is working to educate physicians.

Source: The Atlanta Journal-Constitution, by Alison Young, 22nd March 2009.

60 Whooping Cough Cases – All Were Vaccinated Except One

More than 60 cases of whooping cough have hit Muskingum County, so many that the Zanesville Muskingum County Health Department is calling it an epidemic.

They say the illness, also known as pertussis, has hit every public school district in the county.

Medical director at the health department Vicki Whitacre says they know why it seems to be hitting more 10 and 11 year olds than any other age group.

“We know that the reasoning this is happening is because the immunizations that they receive in kindergarten are starting to wear off,” said Whitacre. “All of the parents of children we’ve talked to have had their immunizations except one.”

The article goes on to say:

Children who have been diagnosed with the illness will have their own natural immunity for four to five years.

Babies also need to get their immunizations, they aren’t safe from it until their booster shot at 15 months.

Source: whiznews.com, by Audry Kensicki. 23rd April 2009.

VAN UK’S Comment: US children have 4 doses of DTaP before 18 months and another dose at 5 years, so if they’re getting whooping cough at 10, that is only ‘lasting’ for 5 years.

When you get the natural disease, you are immune for life, not 4 to 5 years, and this was probably stated so that readers don’t realise they are swapping lifelong immunity for 5 years with the vaccine.

If children aren’t ‘protected’ till 15 months, then the vaccine is a waste of time. Whooping cough doesn’t kill infants over 1 year unless they have other illnesses too, and the most dangerous time is the first 6 months of life.

Over 73% of Whooping Cough Cases Occured In People Vaccinated With At Least One Dose Of Vaccine

Abstract

Although vaccination coverage is high in Catalonia, Spain, pertussis is still a significant cause of morbidity and mortality among infants, overall due to adolescent and adult contacts. An epidemiological study from voluntary health care centres to detect confirmed pertussis cases was carried out in Catalonia. From 465 pertussis-suspect-cases, we identified 126 confirmed events, 73 of them confirmed by laboratory tests. Most of cases were infants less than 4 months old 23 (18.3%), adolescents 22 (17.4%) and adults 46 (36.5%). Sixty-one cases (49.6%) presented paroxysmal cough, 33 (26.8%) post-tussive vomiting and inspiratory whoop, and 27 (22%) apnoea. The vaccination status was not known for 46 (36.5%) patients. Of the total vaccine status documented, 59 (73.8%) patients had received at least one dose. Sixty patients (47.6%) were considered index cases, 32 of them (53.3%) were children under 1-year old. Among contacts identified as pertussis cases, 63.6% (42/66) were older than 14 years of age. These contacts were parents (30), siblings (19), grandmother (4), and others (13). These results confirm protective efficacy of pertussis vaccine only during few time. Regular pertussis boosters in teenagers, and/or in adults who take care of young children, could decrease the incidence of the infection.

Source: Vaccine, Volume 27, Issues 25-26, 26 May 2009, Pages 3489-3491

 Re-emergence of Pertussis In Slovenia

Despite high vaccination coverage for many decades, reported incidence has increased recently, to the highest incidence of 27.5/100,000 in 2006, a 6.5-times increase in comparison to the previous year. Marked shift in age distribution among reported cases was observed in recent years. In 2006, reported age-specific incidence was relatively high in children 8–12 years old, the highest among 9 years old. Similar to other countries, where children are given pre-school boosters, we also have to consider the revision of the national vaccination policy. A booster dose at school entrance or latest at 8 years of age should be introduced to decrease the transmission of disease among school children and to further reduce the burden of disease among infants.

Source: Vaccine,
Volume 26, Issue 15, 28 March 2008, Pages 1874-1878.

Pertussis – A Re-emerging Infection? – ‘It appears that herd immunity does not offer adequate protection to the vulnerable group even in well-vaccinated populations. ‘

Seven cases of pertussis in patients aged between 1 and 6 months detected over 3 months were reported. Paroxysmal cough (six cases), post-tussive vomiting (three cases) and poor feeding (three cases) were the most common presenting symptoms. Bordetella pertussis was isolated from six patients. The total leucocyte counts were mildly increased (10.8–15.6×109/L). The lymphocyte counts were markly raised (59–73%) and appear to be useful indicators of pertussis. It appears that herd immunity does not offer adequate protection to the vulnerable group even in well-vaccinated populations.

Source: Journal of Infection, Volume 48, Issue 2, February 2004, Pages 145-148

Incidence of pertussis in vaccinated and unvaccinated children: Report of 100 cases followed in a child health clinic

This report was from 1955 and unfortunately I am unable to read the full report due to having to purchase it, but the summary says:

It would appear from this study that pertussis is not an uncommon disease and that even in vaccinated children it continues to occur. It may be that the diagnosis is not being made either because of its atypical mild form at the present time or because it is cured by one of the broad-spectrum antibiotics before its full symptomatology erupts.’

So it would appear the report is saying there is just as much whooping cough in the vaccinated as in the unvaccinated and since this dates back to 1955, the DPT vaccine never worked.

Source: The Journal of Pediatrics, Volume 47, Issue 6, December 1955, Pages 716-719

The incidence of Bordetella pertussis infections estimated in the population from a combination of serological surveys

Objectives

Bordetella pertussis circulates even in highly vaccinated populations. There is a considerable amount of infection in adults. For designing more effective vaccination schedules it is important to quantify the age-dependent relation between the number of notified cases and the number of infections.
Methods

We used a statistical relationship between the time since infection and the IgG antibody titers against pertussis toxin, derived from a longitudinal data set, to estimate time since infection for all individuals in a cross-sectional population-based study (1995–1996) based on their titers. Age-specific incidence of infection with B. pertussis was calculated and compared with the age-distribution of notified cases of pertussis in 1994–1996.
Results

Estimated incidence of infection was 6.6% per year for 3–79-year olds, annual incidence of notified cases 0.01%. Estimated age-specific incidence of infection was lowest for 3–4-year olds (3.3%) and increased gradually up to the age of 20–24 years (10.8%). The number of notified cases was highest for 3–9-year olds.

Source: Journal of Infection, Volume 53, Issue 2, August 2006, Pages 106-113.

The relationship between pertussis symptomatology, incidence and serology in adolescents – A Lot Of Teenagers Are Getting Whooping Cough And Going Undiagnosed

Adolescents have an unknown true incidence of pertussis and are important reservoirs of transmission. We evaluated the incidence of coughing illnesses, serologic evidence of recent infection and the relationship between symptomatology and serology in adolescents. A retrospective respiratory questionnaire and anti-pertussis toxin immunoglobulin G measurement was undertaken in a convenience sample of adolescents and was repeated one year later. The US Centers for Disease Control clinical case definition of pertussis was used. At least a third of coughing illnesses met the CDC clinical case definition. Symptoms correlated with serology. Pertussis was endemic with a high annual incidence of new infections.

Source: Vaccine,
Volume 26, Issue 44, 16 October 2008, Pages 5547-5553.

Whooping Cough Still Common Even In The Fully Vaccinated

Whooping cough is a common respiratory infection caused by the bacterium Bordetella pertussis. It should be considered as a possible diagnosis in any adolescent or adult with an acute cough of more than two weeks’ duration, even if they have been fully immunised.

A 17 year old girl presents with a three week history of cough. The cough keeps her awake at night and she has bouts of coughing that disturb her classmates. She is fully immunised. Her general practitioner requests serology for anti-pertussis toxin IgG antibodies, which are found to be raised, indicating a recent infection with Bordetella pertussis.

In the post-vaccination era, whooping cough is under-recognised in primary care as the incidence is incorrectly thought to be low.

Source: BMJ 2009;338:b1772

Whooping Cough Case In A Fully Vaccinated Student

State health officials have confirmed a case of whooping cough at Eastern Alamance High School.

Alamance Burlington school officials learned of the case Friday afternoon and are working together to get students’ parents up to speed.

“We’re able to make contact with those individuals that were in those classrooms as well as those who may have been exposed to the student while riding the school bus,” said Eric Nickens, Alamance County Health Dept. spokesman.

Nickens estimates as many as 100 children may have been exposed to the sick student in the last few weeks, either in the classroom or on a school bus shared with Woodlawn middle school students. The last day of school was Wednesday and employees are cleaning classrooms to disinfect.

“We’ve actually wiped down in the buses, so we have taken some precautions there too,” said Caron Myers, Alamance Burlington Schools System spokeswoman.

The confirmed Alamance case comes as Guilford County’s Health Dept. is offering free TDAP (Tetanus, Diphtheria and Pertussis) vaccination shots. The vaccine protects children from whooping cough and is mandatory for all rising sixth graders.

Myers said the child with whooping cough was up to date on his vaccinations, including TDAP.

Source: Fox 8 News, 13th June 2009.

VAN UK’S Comment: It’s ridiculous to say that pertussis vaccine protects against pertussis and then say the child was fully vaccinated!

3 Cases of Whooping Cough, All Were Vaccinated

Three more area students have been diagnosed with whooping cough, the San Diego County Health and Human Services Agency announced Wednesday.

A 5-year-old at Solana Beach Presbyterian Preschool, an 11-year old at Skyline Elementary and a 14-year-old who goes to Earl Warren Junior High are being treated for the disease, according to the HHSA.

All of the schools are in Solana Beach.

On Tuesday, the HHSA announced that a 5-year-old at Pioneer Elementary School in Escondido also had whooping cough.

HHSA and school officials are working to notify the parents of students who may have been exposed.

“It is not unexpected to see whooping cough in our community,” said Dr. Dean Sidelinger, the county’s deputy public health officer. “Parents need to make sure their children are immunized to protect against vaccine-preventable diseases.”

All of the infected children had been vaccinated.

There were 51 cases of whooping cough reported in the county last year. So far this year, there have been 30 cases.

Source: 10news.com, 10th June 2009.

Child Gets Whooping Cough After FIVE Vaccines

A 5-year-old kindergarten student at Pioneer Elementary School is recovering from pertussis, or whooping cough, health officials said Tuesday.

The child developed the bacterial disease even after receiving the recommended five-part course of vaccinations, officials said. County Public Heath Officer Wilma Wooten explained that while the whooping cough vaccine greatly reduces the risk of developing the illness, no vaccine is 100 percent effective.

Source: North County Times, 9th June 2009.

Atypical Pertussis in Fully Vaccinated Children

From October 2005 to March 2006, a laboratory-confirmed outbreak of pertussis occurred in preschool-aged children (1-4 years) in Toronto, Canada. A case-control study in children was done to identify the risk factors for being positive for Bordetella pertussis by polymerase chain reaction (PCR).

The main risk factors for PCR positivity for B. pertussis were school or day care attendance. Atypical symptoms were likely moderated by high immunization rates or may have been caused by other respiratory pathogens. In some cases, a positive PCR result might simply have reflected transient nasopharyngeal carriage of B. pertussis.

Source: The Pediatric Infectious Disease Journal:
July 2009 – Volume 28 – Issue 7 – pp 582-587

New Form of Pertussis in Highly Vaccinated Population

Bordetella pertussis isolates not expressing Pertussis Toxin (PT) or Pertactin (PRN) have been collected, for the first time in 2007, in France, a highly vaccinated country with acellular vaccines. Non-expression was due to deletion of the entire ptx locus, to IS481 insertion in the prn gene or deletion of a part of this gene. Genome sequencing does not indicate any regions of differences when compared to other circulating isolates. It nevertheless shows some sequence differences and an increased number of repeated sequences. The infant infected by the isolate not expressing pertussis toxin, did not present hyperlymphocytosis. All isolates were found less pathogen in animal or cellular models; their circulation raises the problem of clinical and biological diagnoses.

Source: Vaccine, Volume 27, Issue 43, 9 October 2009, Pages 6034-6041.

Whooping Cough in Fully Vaccinated Child

A 4-year-old child who attends La Jolla Children’s Learning Lab at has been diagnosed with pertussis, commonly known as whooping cough, the County of San Diego Health and Human Services Agency (HHSA) announced Tuesday.

The student was up-to-date on immunizations.

Source: Del Mar Times, 1 December 2009.

Pertussis is Increasing in Highly Vaccinated Populations

Context Reported cases of pertussis among adolescents and adults have increased since the 1980s, despite increasingly high rates of vaccination among infants and children. However, severe pertussis morbidity and mortality occur primarily among infants.

Objective To describe the trends and characteristics of reported cases of pertussis among infants younger than 12 months in the United States from 1980 to 1999.

Design, Setting, and Participants Cases of pertussis in infants younger than 12 months in the United States reported to the National Notifiable Disease Surveillance System of the Centers for Disease Control and Prevention between 1980 and 1999, and detailed case data from the Supplementary Pertussis Surveillance System.

Main Outcome Measures Incidence and demographic and clinical characteristics of cases.

Results The incidence of reported cases of pertussis among infants increased 49% in the 1990s compared with the incidence in the 1980s (19 798 vs 12 550 cases reported; 51.1 cases vs 34.2 cases per 100 000 infant population, respectively). Increases in the incidence of cases and the number of deaths among infants during the 1990s primarily were among those aged 4 months or younger, contrasting with a stable incidence of cases among infants aged 5 months or older.

Source: JAMA. 2003;290:2968-2975

Baby Had First ‘Immunisation’, Ended up in Hospital With Whooping Cough

This article was a pro-vaccine article blaming whooping cough on unvaccinated children, but it said:

Natalie Larkin of Beaumont said her 3½-month-old daughter, Kate, had cold symptoms for a week before whooping cough was diagnosed. Kate, who had undergone her first immunisation, ended up in hospital for four days.

“It’s scary.. They choke,” she said.

If they actually looked at the status of those infected, they would find that the majority are partially or completely vaccinated or they are adults who were fully vaccinated as children.

Source: Adelaide Now, 5 November 2009.

New Form of Pertussis Caused By Acellular Pertussis Vaccine

THE bacteria that causes whooping cough in Australia has mutated, scientists have warned, eroding the protection provided by the vaccine now given to children.

Researchers from the University of New South Wales have identified significant changes in the two most common strains of the Bordetella pertussis bacteria, which they also traced back to events in the late 1990s.

Australian children were given a broad-acting “whole cell” vaccination against whooping cough up to 1997, but this was phased out over two years and replaced with a more targeted version. Concerns over potential side-effects were behind the change over to a vaccine with a narrower scope, but this now appears to have contributed to the promotion of resistant strains.

“A key issue is that the whole cell vaccine contained hundreds of antigens, which gave broad protection against many strains of pertussis,” said Associate Professor Ruiting Lan of the UNSW School of Biotechnology and Biomolecular Sciences.

“But the (targeted) acellular vaccine contains only three to five antigens.

“Our findings suggest that the use of the acellular vaccine may be one factor contributing to these genetic changes.”

The research team analysed more than 200 samples of the bacterium collected over the past 40 years in Australia, and these were compared with samples from Japan, Canada, USA and Finland.

They found while the vaccine now in use was effective against some of the strains circulating in Australia it may no longer protect against two strains, known as MT27 and MT70.

Dr Lan said more research was needed to confirm the results but health authorities may need to modify the vaccine to broaden the protection it offered, “or over time it could lose effectiveness as the organism evolves”.

The discovery comes amid an increase in whooping cough cases in Australia, with several significant outbreaks seen last year in western Sydney.

Source: news.com.au, 10 February 2010.

Whooping Cough in Vaccinated Student

School officials announced this week that a fourth grade student at Meadow Pond Elementary School had been diagnosed with pertussis, also known as whooping cough. While the district emphasized that “there was no cause for alarm,” a letter to parents on Monday encouraged them to contact their child’s doctor if the child develops a persistent cough.

While most children receive vaccines against pertussis, in some people vaccines may not work.

According to the district, the child at Meadow Pond was infected despite their vaccination.

Source: Lewisboroledger.com, 24 February 2010.

Whooping Cough Due to Vaccine Waning

Central Texas doctors are seeing a surge in the number of children coming down with whooping cough.

In total, the Austin-Travis County Health and Human Services Department said nearly 500 cases of whooping cough, which starts out with symptoms similar to a cold, have been confirmed or considered probable cases.

“It can be a very severe illness, and that’s why it’s really important to stay on top of this and prevent the spread,” Austin-Travis County Medical Director Dr. Philip Huang said.

Of the 200 confirmed or probable cases of pertussis reported in Williamson County this year, the majority are kids in school.

No deaths have occurred this year in our area as a result of the increase, but Jennifer Jackson, with the Williamson County and Cities Health District, said unvaccinated or under-vaccinated infants are at high risk of becoming seriously ill if they contract the infection through the air.

“Going into this year we’re seeing many more cases,” Jackson said.

Eanes Independent School District sent home a letter to parents of children attending Barton Creek Elementary School this week, notifying them that a couple of students had contracted the infection. A similar letter was sent to Westlake High School parents right before spring break.

One pediatric physician at Dell Children’s Medical Center said he’s seen about 200 cases since the middle of February.

“Kids who are getting vaccinated, as they get older, we used to think didn’t need any routine booster or re-immunization. Now, we’re finding out that they do. And so consequently, the kids 10-14 years old are able to get pertussis and consequently spreading it to younger children,” Dr. Robert Vezzetti said.

Local doctors said they have also seen a trend in adults, with milder symptoms, spreading the infection to children.

“If you have a 30-year-old or 40-year-old adult, they can easily get pertussis and their symptoms may not be as severe necessarily,” he said.

Source: News 8 Austin, 24 March 2010.

Evidence of Bordetella pertussis infection in vaccinated 1-year-old Danish children.

We measured IgA and IgG antibodies to pertussis toxin (PT) and filamentous hemagglutinin (FHA) in sera from 203 1-year-old children who had received one to three doses of a monocomponent PT toxoid vaccine. Ten children (5%) had IgA antibody to PT indicating recent infection; seven of these children had received three doses of vaccine. PT IgA responders did not have significantly longer coughing episodes than PT IgA non-responders. Since an IgA antibody response occurs in only approximately 50% of infected children, the actual infection rate in our cohort is estimated to approximately 10%. The apparent high Bordetella pertussis infection rate in Danish infants suggests that the monocomponent PT toxoid vaccine used in Denmark has limited efficacy against B. pertussis infection. A prospective immunization study comparing a multi-component vaccine with the present monocomponent PT toxoid vaccine should be undertaken.

Source: Eur J Pediatr. 2010 Apr 8. [Epub ahead of print

Whooping Cough outbreak Due to Vaccine Waning

KTSP.com in Minneapolis/St. Paul has reported an outbreak of pertussis in schools in Wright County.

There have been 46 cases so far primarily in students from Maple Lake Elementary and St. Timothy’s Catholic School.

Most cases are in 5th and 6th graders and the outbreak may be due to waning immunity from vaccinations received when they were toddlers. Booster shots are given to 7th graders.

Source: The Examiner, 14th May 2010.

Whooping Cough Remains a Threat Despite Vaccine

Baby Dies of Whooping Cough after Catching it from Dad Who Was Vaccinated as a Baby

Whooping cough has made a comeback, and right now California is in the midst of its worst outbreak in half a century with 3,600 cases and eight deaths.

Last year, Texas had 3,358 cases of the pertussis disease, which is also the most in fifty years. Three deaths were reported.

“Pertussis itself is a very bad bug, it is highly contagious,” said UT Health Pediatrician Jason Sanders.

Doctors say the increase is due partly because the series of pertussis vaccinations you get as a child, does not provide lifetime immunity. The vaccine wears off by about age 12.

That’s what happened to the Throgmorton family.

In 2003, Haleigh Throgmorton came into the world a little ahead of schedule, so her father delivered her at home near Amarillo. Five-and-a-half weeks later Haleigh died from pertussis.

“It was a shock, I mean we were floored that that’s what it was, because it was something you never thought of being around anymore,” said Jerri Lynn Throgmorton, the baby’s mother.

Rodney Throgmorton, who hadn’t been immunized since childhood, got whooping cough at age 34 and then unknowingly passed it on to his newborn.

“By the time she passed away I had had the disease for a month, and coughing for a month,” he said.

The disease is uncomfortable for adults, but can be deadly for infants under 6 months old, who haven’t been fully immunized.

That’s why in 2005, the U.S. Food and Drug Administration approved
a whooping cough booster for everyone over age 11.

But there is another side to this story that is far more controversial.

Some doctors wonder if the actions of some parents are partly to blame for the rise of the disease. A growing number of them have decided not to vaccinate their children.

Rebecca Rex is among those parents.

“I’m fully aware of the risk we’ve taken and the consequences of those risks if they don’t go well,” she said.

Her two sons, ages 17 and 11, have never been vaccinated
and she said they have never gotten whooping cough.

Rex is the co-founder of Parents Requesting Open Vaccine Education, or PROVE. She says there is evidence that vaccines can have dangerous side effects.

“I’m not telling a parent to vaccinate or not, I am telling a parent to go out and do as much research as they can — of information that is not hysterical,” Rex said.

11News checked with the Centers For Disease Control and found they have what’s called the Adverse Vaccine Reporting System. We found reports where people said that within minutes, or hours of getting the pertussis vaccine, they suffered from either abdominal pain, nausea, seizures or rashes. And in rare cases, some children died.

Source: Kvue.com, 10th September 2010.

85.9% of Children in Whooping Cough Outbreak Were Vaccinated

Abstract

Objective To estimate the proportion of school age children with a persistent cough who have evidence of a recent Bordetella pertussis infection.

Design Prospective cohort study (October 2001 to March 2005).

Setting General practices in Oxfordshire, England.

Participants 172 children aged 5-16 years who presented to their general practitioner with a cough lasting 14 days or more who consented to have a blood test.

Main outcome measures Serological evidence of a recent Bordetella pertussis infection; symptoms at presentation; duration and severity of cough; sleep disturbance (parents and child).

Results 64 (37.2%, 95% confidence interval 30.0% to 44.4%) children had serological evidence of a recent Bordetella pertussis infection; 55 (85.9%) of these children had been fully immunised. At presentation, children with whooping cough were more likely than others to have whooping (odds ratio 2.85, 95% confidence interval 1.39 to 5.82), vomiting (4.35, 2.04 to 9.25), and sputum production (2.39, 1.14 to 5.02). Children with whooping cough were also more likely to still be coughing two months after the start of their illness (85% v 48%; P = 0.001), continue to have more than five coughing episodes a day (P = 0.049), and cause sleep disturbance for their parents (P = 0.003).

Conclusions For school age children presenting to primary care with a cough lasting two weeks or more, a diagnosis of whooping cough should be considered even if the child has been immunised. Making a secure diagnosis of whooping cough may prevent inappropriate investigations and treatment.

Source: http://www.bmj.com/content/333/7560/174.abstract

17 Cases of Whooping Cough, All Were Fully Vaccinated

A rise in the number of pertussis cases in the area has hit two Orange County elementary schools particularly hard.

“We had 11 cases 2 weeks ago. Now we have 17,” said Gene Kotulka, director of student services for the school system.

Kotulka said tests on four other students Friday came back negative, “but it comes in waves, so we may see more.”

All of the affected students attend either Lightfoot Elementary or Unionville Elementary, which are near each other on U.S. 522. According to Kotulka, all the students have been vaccinated.

Source: fredericksburg.com, 22nd November 2010.

Stop Blaming Parents Who Don’t Vaccinate for Whooping Cough, Your Vaccines DON’T WORK!

Imperfect vaccine-induced immunity and whooping cough transmission to infants

Abstract
Whooping cough, caused by B. pertussis and B. parapertussis, has increased in incidence throughout much of the developed world since the 1980s despite high vaccine coverage, causing an increased risk of infection in infants who have substantial disease-induced mortality. Duration of immunity and epidemically significant routes of transmission across age groups remain unclear and deserve further investigation to inform vaccination strategies to better control pertussis burden. The authors analyze age- and species-specific whooping cough tests and vaccine histories in Massachusetts from 1990 to 2008. On average, the disease-free duration is 10.5 years. However, it has been decreasing over time, possibly due to a rising force of infection through increased circulation. Despite the importance of teenage cases during epidemics, wavelet analyses suggest that they are not the most important source of transmission to infants. In addition, the data indicate that the B. pertussis vaccine is not protective against disease induced by B. parapertussis.

Source: Vaccine, Volume 29, Issue 1, 10 December 2010, Pages 11-16.

Whooping Cough Vaccine Not Working: New Strain of Pertussis Developing

Matthew Jacob Bryce was born a healthy 8 pounds, 9 ounces on Oct 11, 2010, so when he showed signs of a cold at just two weeks, his parents knew something more might be wrong. They were not first-time parents.

“He was just really stuffy. He was having difficulty breathing,” Marlon Bryce, Matthew’s father, recalled.

The doctor suspected whooping cough, although everyone in the house had been vaccinated. For Marlon and Cindy Bryce, a young couple who had met in San Diego when both were in the Navy, it was a terrible prospect. Whooping cough, known also as pertussis, can be fatal in babies.

The doctor took a nasal swab, and started the infant on antibiotics.

It took six days to get the lab results. Matthew, at 23 days old, had pertussis.

California is experiencing its worst whooping cough outbreak in more than 60 years. Thousands of people have gotten sick and 10 infants have died, including two in San Diego County.

Health officials across the country are trumpeting pertussis vaccinations, but a four-month investigation by KPBS and the Watchdog Institute, a nonprofit investigative center based at San Diego State University, has found that many people who have come down with whooping cough have been immunized.

Two of the world’s most respected experts on the disease disagree about why there are such high numbers of people who are getting sick. Dr. James Cherry, a prominent researcher at UCLA, says increased awareness of whooping cough has led to more reports of it. However, Dr. Fritz Mooi, a well-known Dutch scientist who has been studying mutations of the pertussis bacteria for 15 years, says a more virulent strain of bacteria is contributing to outbreaks.

KPBS and the institute have been asking about the possibility of more virulent whooping cough strains for months, and the Centers for Disease Control and Prevention (CDC) recently announced studies of the disease, and the bacteria causing it, in California and Ohio. Two members of the California study group said it was prompted by the increasing death toll and KPBS-institute inquiries.

Officials from the CDC, the California Department of Public Health (CDPH) and two pertussis experts from UCLA held a conference call Oct. 13 to discuss studying whether a more virulent strain was responsible for infant deaths and is contributing to the current epidemic. That same day, whooping cough claimed the life of its tenth newborn in California.

Dr. Jeff Miller, a scientist involved in the study at UCLA, said the possibility that the pertussis bacterium has mutated “is an important hypothesis to test.” He added, “I wish we would have started it in 2005.”

Mooi, the scientist who has been studying the bacterial mutations, said his research has been ignored by those who influence public policy on pertussis in the U.S. and beyond, in part because they rely on vaccine makers to fund their meetings and research.

There is little incentive for pharmaceutical companies to pursue a new vaccine because it would cost billions, he said. The circulation of a more virulent strain of pertussis could mean a new vaccine should be created.

VideoAbove: Dr. Frits Mooi is a scientist with The Netherlands Center for Infectious Diseases Control. Mooi says his research suggests there is “mis-match” between the current pertussis vaccine and a new more virulent strain of the disease which is now circulating.
In examining the pertussis epidemic, KPBS and the Watchdog Institute collected federal, state and county statistics and consulted and interviewed experts from Los Angeles to the Netherlands.

Key findings include:

• For pertussis cases in which vaccination histories are known, between 44 and 83 percent were of people who had been immunized, according to data from nine California counties with high infection rates. In San Diego County, more than two thirds of the people in this group were up to date on their immunizations.

• Health officials in Ohio and Texas, two states also experiencing whooping cough outbreaks, report that of all cases, 75 and 67.5 percent, respectively, reported having received a pertussis vaccination.

• Today, the rate of disease in some California counties is as high as 139 per 100,000, rivaling rates before vaccines were developed.

• Public officials around the world rely heavily on two groups of pertussis experts when setting vaccine policy relating to the disease. Both groups, and many of their members, receive money from the two leading manufacturers of pertussis vaccine.

Pertussis is a highly contagious respiratory illness that may mimic a cold for the first 10 days. It then can produce a violent and persistent cough with a unique “whooping” sound.

For adults, pertussis may only be a nuisance, like a bad cold. But to infants it can be deadly because they can’t cough up what collects in their lungs and infections can spread.

Vaccinations nearly wiped out whooping cough more than 30 years ago, but it has made a vengeful comeback in California and other highly vaccinated communities around the U.S.

While public health officials and scientists agree that vaccines are still the best available tool against pertussis, they argue over how effective they are with time and in the face of a possible increase in virulence.

Dr. Mark Horton, director of the California Department of Public Health, said health officials expect to see a certain percentage of people who have been vaccinated contracting whooping cough. He says no vaccine is 100 percent effective, and those who are immunized and getting sick are likely those for whom the vaccine did not work or whose immunity has waned.

“That’s no surprise to us,” he said, “nor is it a reflection on the efficacy of the vaccine.”

Mooi, who heads the Pertussis Surveillance Project at the National Institute of Health in the Netherlands, said an epidemic in 1996 in his country gave the need for research more urgency.

“And we found really a kind of new mutation in that bug,” Mooi said.

In tests, Mooi’s lab found the mutated strain produced more toxins, which could make people sicker.

At the Bryces’ home in Chula Vista, Marlon, who is 31 and a contract specialist at the Naval Medical Center, and Cindy, 27, puzzle over how Matthew could have contracted pertussis. He hadn’t been out of the house much, they said.

Their other boys Jordan, 4, and Joshua, 3, were up to date on their vaccinations. Marlon had gotten his a month before Matthew was born. Cindy was immunized before leaving the hospital after giving birth.

Marlon clearly remembers Cindy’s call when she learned Matthew had whooping cough. “She was crying … The moment that I heard it, I immediately started thinking the worst. You’ve heard the news about the babies that have passed away … Why is this happening?”

Marlon is soft-spoken and thoughtful.

“The one thing I would want to know is: Is the vaccine working? Is it as effective? … I thought that if I did everything I was told to do that our sons would be protected,” Marlon said.

The bacterium that causes whooping cough was first identified in 1906, when the illness was a common cause of death in infants and young children.

The discovery lead to the first attempts at a vaccine, but it wasn’t until the late 1940s, when the rate of disease was around 157 cases per 100,000 population, that scientists developed a vaccine effective enough to prevent pertussis. By the 1970s, the pertussis infection rate had dropped to less than one per 100,000.

But the vaccine, made of whole bacterial cells killed in labs, had side effects, such as prolonged crying spells in babies and seizures.

By 1996, the FDA approved a new whooping cough vaccine: an acellular version, which uses only purified components of the disease-causing organism. It is considered safer than the whole-cell vaccine and is the only one used in the U.S. today.

Just as the vaccines were changing, health officials across the country were reporting increasing numbers of whooping cough cases. According to a CDC report, most of the children four years old and younger who got whooping cough nationwide between 1990 and 1996 were not fully immunized.

That trend appears to have reversed in California’s latest outbreak.

KPBS and the Watchdog Institute requested information from 19 California counties most affected by pertussis. Nine counties supplied pertussis case information and vaccination history. In all but Stanislaus County, more than half the people sick with whooping cough had been immunized.

As of the end of October, and in cases where immunization history was known, data showed 83 percent of the people with whooping cough in Fresno had been vaccinated. In San Luis Obispo, 76 percent were up to date on their immunizations. In San Diego, 68 percent were up to date.

Public health experts say the surge of the disease is cyclical, with increased diagnoses every two to five years.

“And that tells us bordatella pertussis is circulating today exactly as it did in the prevaccine era,” Cherry said. “The main reason is increased awareness,” he explained. “People, particularly public health people, are much more aware, and that trickles down.”

Cherry and Mooi agree that immunity provided by vaccines wanes over time. But, they disagree over how long immunity lasts, and whether a mutated strain of pertussis is exploiting waning immunity.

Dr. James Cherry says there is no evidence current whooping cough vaccines are less effective then they were 15 years ago.
Drug package inserts included with the two most common pertussis vaccines in the U.S. state they are 85 percent effective. Cherry, who was involved in the efficacy studies when the vaccines were licensed by the FDA, estimates the efficacy is between 70 and 80 percent. Mooi said there’s no way to know how effective the vaccines are because they haven’t been tested against the new strain.

“The vaccines have less efficacy than many people believe,” Mooi said.

Public health agencies recommend five vaccine doses by age 6, and they recommend adults get a booster every 10 years. The California state legislature passed a law in September requiring all children entering middle school to receive a pertussis booster.

Cherry advocates booster shots. Mooi isn’t so sure adult boosters are cost effective. Both agree that the current vaccine offers the best protection against the disease, especially for families with an infant in the house.

In the long run, Mooi says there should be better vaccines.

Money should be spent studying today’s strains and making a vaccine that would work against them, Mooi said. “After all, every year we have a new flu vaccine, so, I think we should have something like that for bacterial vaccines, too,” he said.

Cherry believes a new, better vaccine is a long way off.

“I think the likelihood of the logistics of getting a new vaccine right now in this country is almost impossible, because of the FDA rules and requirements,” he said. “There’s a lot of things you could do (to improve current vaccines), but to get it approved would cost billions of dollars.”

Cindy and Marlon Bryce were certainly aware of the deadly nature of whooping cough. Six weeks in October and November were harrowing for them. Today, their routine is more normal. Matthew has started day care.

“The one thing I would want to say to parents is watch your kids, just be concerned,” Marlon said. “At first we thought we were being overprotective. But I’m glad we were.”

He continued, “I would just hope that there is something we can do about this. If there’s something that we can do, if there’s something that the scientists who look at these things every day, if they think that there’s a better way to do this, if there’s a way that they can improve this vaccine, then please. I would support it.”

Source:KPBS, by Joanne Faryon and Kevin Crowe, Watchdog Institute, 14th December 2010.

 Pertussis Spread to Neonates by ‘Immunised’ Staff

The highly transmissible nature of pertussis has been highlighted by an incident at a Sydney maternity hospital in which a fully-immunised nurse infected four neonates.

Described this week in Communicable Diseases Intelligence, the incident shows that extra vigilance is needed in healthcare staff working with newborns, in whom any coughing illness must be suspected to be pertussis, say the report authors.

Source: 6Minutes of interesting stuff for doctors today, 31st January 2011. http://www.6minutes.com.au/news/pertussis-spread-to-neonates-by-immunised-staff

When Immunity Fails – up to 83% of Whooping Cough Epidemic Sufferers are Vaccinated

For the past four months, KPBS and the Watchdog Institute have tracked the whooping cough epidemic across California and other affected states. In an effort to better understand who is getting sick, we examined data from San Diego County Health and Human Services agency that contained immunization history for each person diagnosed with pertussis. In September, KPBS reported that almost two-thirds of the people diagnosed with pertussis in San Diego County had been up to date on their immunizations. The figure surprised local health officials.

The institute then requested similar information from the California Department of Public Health. Each local health jurisdiction is responsible for reporting detailed information on probable pertussis cases to the state health department. The department keeps track of the information electronically and submits it to the Centers for Disease Control and Prevention (CDC).

In September, we received the state’s data on pertussis cases, and found it was not up to date and was missing information. For example, the immunization history was marked “unknown” for more than 60 percent of the cases. The state’s figures for San Diego County also didn’t match what the county had given us. We asked the state about the discrepancies, and officials responded that if we wanted timely and accurate information, we should ask each county’s health department.

Within days, we began requesting immunization history information from counties that reported high numbers of cases of pertussis. Of the 19 contacted, nine responded with immunization information. Officials from the other counties said they either didn’t have the data, or they cited patient privacy in withholding it.

The institute’s analysis of the data provided showed that in cases where immunization history is known between 44 and 83 percent of the people diagnosed with whooping cough had been vaccinated.

A more recent set of data from the state showed the California Department of Public Health still does not have immunization history information for almost 70 percent of the reported cases. However, in cases where immunization history is known, 83 percent of the people diagnosed with pertussis had been immunized.

To better understand the current epidemic, reporters for KPBS and the Watchdog Institute traveled to Los Angeles, Sacramento and the Netherlands to interview the world’s leading experts on pertussis, health officials and vaccine experts. They also reviewed recent studies done on pertussis, interviewed local families about their experiences with the disease and filed California Public Records Act and federal Freedom of Information Act (FOIA) requests for information on the epidemic and efforts to respond to it.

The CDC recently stopped answering questions about ongoing studies of whooping cough and its response to outbreaks nationwide. The CDC still has not produced records in response to a FOIA request the institute filed in September for information relating to past whooping cough epidemics.

Source: Watchdog Institute, 17th December 2010.

Levels of Pertussis Antibodies Very Low in ‘Immunized’ Children Aged 2-20

Background: This multicenter study was undertaken to investigate the serologic evidence of antibodies to Bordetella pertussis toxin (IgG-PT) in children and adolescents.

Methods: IgG-PT value in a single serum collected from 1616 children and adolescents was measured by enzyme-linked immunosorbent assay in the Food and Drug Administration (FDA)-units per milliliter from November 2008 to October 2009. The relationship between time since infection and IgG anti-PT levels were analyzed and the estimated age-specific incidences of infection were calculated.

Results: The sera IgG-PT geometric mean concentrations of the samples were 1.7 FDA-U/mL. The sera protective rates of all the subjects were 6.6% (95% confidential interval [CI]: 5.4%, 7.8%). The rates in the group aged 2 years was 9.2% (95% CI: 3.5%, 14.9%), which was significantly higher than in those aged >=3 years ([chi]2 = 1615, P = 0.000). In the group aged >=3 years, 4.0% (95% CI: 3.0%, 5.0%) of the individuals tested showed an IgG-PT level >=40 FDA-U/mL, which was equivalent to an estimated incidence of B. pertussis infection of 7000 (95% CI: 5300, 8800) per 100,000 population per year in the year before serum sampling. There were 2 peaks of estimated incidence. One peak incidence of 9100 (95% CI: 4300, 14000) per 100,000 population per year was found in the population aged >6 to 8 years. Another peak was in the population of 12- to 20-year olds with the estimated incidence of 14,600 (95% CI: 9100, 20100) per 100,000 per year.

Conclusions: The levels of protective antibodies against pertussis were very low in the immunized children aged 2 to 20 years. A booster dose of immunization for older children or adolescents should be an urgent priority. Moreover, using enzyme-linked immunosorbent assay to determine the efficiency of vaccines and even to obtain the serodiagnosis would be beneficial in controlling pertussis.

Source: Pediatric Infectious Disease Journal:
POST AUTHOR CORRECTIONS, 18 March 2011
doi: 10.1097/INF.0b013e31820eaf88.

VAN UK’s Comment: Children are given as many as 5 injections, in some countries the final one being at age 18 months and they say children aren’t immune by 2?

 Whooping Cough Vaccine Fades after 3 Years

The whooping cough vaccine given to babies and toddlers loses much of its effectiveness after just three years — a lot faster than doctors believed — and that could help explain a recent series of U.S. outbreaks among children who were fully vaccinated, a study suggests.

The study is small and preliminary, and its authors said the results need to be confirmed through more research. Nevertheless, the findings are likely to stir debate over whether children should get a booster shot earlier than now recommended.

“I was disturbed to find maybe we had a little more confidence in the vaccine than it might deserve,” said the lead researcher, David Witt, chief of infectious disease at the Kaiser Permanente Medical Center in San Rafael, Calif. Dr. Witt presented his findings Monday at a conference in Chicago.

Source: Post-Gazette.com, 20 September 2011.

 5 Year old Vaccinated Child got Whooping Cough

Health officials confirm a student at Pink Hill Elementary School in Lenoir County has been diagnosed with Whooping Cough.

The Lenoir County Health Department tells Nine On Your Side a 5-year-old boy was diagnosed with Whooping Cough, or pertussis – a highly contagious bacterial infection. No word on when the child first became ill. Officials say the boy was previously vaccinated, and that chances of getting Whooping Cough with immunization is very unlikely.

They say he didn’t get all the doses due to vaccine reactions. Number of doses needed for immunity varies by country.

Source: Eyewitness News, 31st October 2011.

Whooping Cough Vaccine Fades after 3 Years

The whooping cough vaccine given to babies and toddlers loses much of its effectiveness after just three years — a lot faster than doctors believed — and that could help explain a recent series of U.S. outbreaks among children who were fully vaccinated, a study suggests.

The study is small and preliminary, and its authors said the results need to be confirmed through more research. Nevertheless, the findings are likely to stir debate over whether children should get a booster shot earlier than now recommended.

“I was disturbed to find maybe we had a little more confidence in the vaccine than it might deserve,” said the lead researcher, David Witt, chief of infectious disease at the Kaiser Permanente Medical Center in San Rafael, Calif. Dr. Witt presented his findings Monday at a conference in Chicago.

The study was done in California, where whooping cough vaccinations are a hot-button issue. The state had a huge spike in whooping cough cases last year, during which more than 9,100 people fell ill and 10 babies died. California schools have turned away thousands of middle and high school students this fall who haven’t gotten their booster shot.

Government health officials recommend that children get vaccinated against whooping cough in five doses, with the first shot at age 2 months and the final one between 4 and 6 years. Then youngsters are supposed to get a booster shot around 11 or 12. That means a gap of five to eight years.

Dr. Witt’s study looked at roughly 15,000 children in Marin County, Calif., including 132 who got whooping cough last year. He found that youngsters who had gone three years or more since the last of their five original shots were as much as 20 times more likely to become infected than children who had been more recently vaccinated.

Read more: http://www.post-gazette.com/pg/11263/1176014-114-0.stm#ixzz1dKvC1AXN

Source: New Microbiol. 2009 Jul;32(3):317-8. http://www.ncbi.nlm.nih.gov/pubmed/19845117

13 Kids Get Whooping Cough, ALL were Vaccinated

Thirteen kids in the Smithtown School District has contracted pertussis, a highly contagious bacterial infection also known as whooping cough, Suffolk County Health Commissioner James L. Tomarken announced Tuesday.

Cases were confirmed in St. James Elementary School, Tackan Elementary School and Nesaquake Middle School, and the health department has advised school officials to begin infection control measures.

According to the health department, all the infected children had been immunized, which explains why they only came down with mild cases of the infection.

Source: SmithtownPatch, 21 June 2011. http://smithtown.patch.com/articles/13-kids-contract-whooping-cough-at-smithtown-schools

VAN UK’s Comment: My 2nd daughter had whooping cough 14 years ago. Hers was a mild case and she was unvaccinated. That is just an excuse they use to explain why the vaccine doesn’t work.

82 People Get Whooping Cough, All were Vaccinated. Authorities Say ‘Still Get Your Vaccine!’ (Yes, that is such a good sales pitch, makes me want to get 10!).

Thursday, the Alamance County Health Department said they now have 82 confirmed cases. The Health Department also said all of those cases had previously received the pertussis vaccine.

The vaccination for whooping cough, also known as pertussis, has changed. Back in 1991, doctors reformulated the vaccine because some children were having severe reactions to the original vaccine.

“What we’re finding is that this vaccine is safer. But, the downside is that it’s not producing antibodies that are as protective as the old, cellular pertussis vaccine. The answer to everyone is…look, you still get the vaccine,” Guilford County Health Department Medical Director Ward Robinson said.

Source: Digtriad.com, 24th February 2012.

More kids in California Pertussis Epidemic Vaccinated

During a whooping cough outbreak in California in 2010, immunized children between eight and 12 years old were more likely to catch the bacterial disease than kids of other ages, suggesting that the childhood vaccine wears off as kids get older, according to new research.

“We have a real belief that the durability (of the vaccine) is not what was imagined,” said Dr. David Witt, an infectious disease specialist at Kaiser Permanente Medical Center in San Rafael, California, and senior author of the study.

Whooping cough, or pertussis, is caused by Bordetella pertussis bacteria. The infection produces an intense cough that lasts weeks and can lead to pneumonia, an inability to breathe or death — although most cases don’t reach such extremes.

In early 2010, a spike in cases appeared at Kaiser Permanente in San Rafael, and it was soon determined to be an outbreak of whooping cough — the largest seen in California in more than 50 years.

Witt had expected to see the illnesses center around unvaccinated kids, knowing they are more vulnerable to the disease.

“We started dissecting the data. What was very surprising was the majority of cases were in fully vaccinated children. That’s what started catching our attention,” said Witt.

Source: http://www.reuters.com/article/2012/04/03/us-whoopingcough-idUSBRE8320TM20120403

 97.1% of Pertussis Cases were Fully Vaccinated, Doctors Don’t Know What Level of Antibodies Immunise

Of the 35 cases enrolled in our study, 23 were male (65.7%) and 12 were female (34.3%). Their ages varied between 2 months and 13 years (mean: 6.5 ± 3.9 years) (Table I). Three of the cases were aged ≤3 months. Four cases were aged <1 year. There were 4 cases in the age group 1-4, 11 cases in the age group 5-8, 11 cases in the age group 9-12, and 5 cases in the age group 13-16 (Table I). Thirty-four of the cases (97.1%) were fully vaccinated according to their ages. One case aged 2 months was not vaccinated.

Because antibody levels were tested qualitatively and semi-quantitatively in our study and 34 of the cases (97.1%) were fully vaccinated according to their ages, a cut-off value to determine whether the positivity in their antibody level was due to vaccination or infection could not be specified.

The fact that our cases did not include any patient with culture-confirmed pertussis may be attributed to the fact that 97.1% of the cases were fully vaccinated according to their ages.

PT is the single antigen that is specific for B. pertussis and it is considered that IgG antibodies developed against PT may be responsible for long-term immunity3,11,15. Although it has been reported that the detection of high levels of IgG antibodies against PT in a single serum sample is diagnostic of recent or acute infection with B. pertussis, when antibody levels according to age groups are known in the society19, the cut-off value indicating prevention has not yet been determined32.

Type IgM and IgG antibodies are produced after vaccination; however, the type IgA antibodies that develop after vaccination are in very low concentrations8,11. Although pertussis vaccines have been in use for a long time, reliable antibody levels that determine immunity have not yet been identified11.

Because antibody levels were tested qualitatively and semi-quantitatively in our study and 34 of the 35 cases (97.1%) were fully vaccinated according to their ages, a cutoff value to determine whether the positivity in their antibody level was due to vaccination or infection could not be specified.

Source:

Comparison of Nasopharyngeal Culture, Polymerase Chain Reaction (PCR) and Serological Test for Diagnosis of Pertussis
Ali Bülent Cengiz1, İnci Yıldırım1, Mehmet Ceyhan1, Gülten Seçmeer1 Deniz Gür2, Ateş Kara1
1Infectious Disease Unit, Department of Pediatrics, and 2Pediatric Microbiology Laboratory, Hacettepe University Faculty of Medicine, Ankara, Turkey

http://www.turkishjournalpediatrics.org/?fullTextId=673&lang=eng

Vaccine is a Dud says Doctor

A WHOOPING cough epidemic is sweeping Australia and according to one Ipswich doctor the current vaccine is the reason why.

Ipswich Medical Centre GP Paul Curson said many of the people he had treated during this epidemic were fully immunised, suggesting the vaccine was failing to protect people.

So far this year 490 cases of Pertussis (whooping cough) have been reported in the West Moreton Health Services District, up from 436 last year but far in excess of the 50 cases in 2007.

Dr Carson, a veteran of 30 years as a GP, said the current vaccine was simply not doing its job.

“The vaccine is no good, we’re seeing whooping cough in people that shouldn’t really have it,” Dr Curson said.

“It is showing up in kids that have been vaccinated.”

Dr Heidi Carroll, a public health physician with Queensland Health’s Communicative Diseases Control Service said Dr Curson’s claim was baseless.

“No vaccine is 100% effective, the Pertussis vaccine is about 80-90% effective,” she said.

“What it is really good at is preventing death and serious illness. People can still pick up the illness (but) it is often a lot milder than it otherwise would have been.

“It’s true we are getting more young people coming through but that is because of the epidemic.”

Dr Curson blamed a change from a cellular vaccine to an A- cellular version in the late 1990’s for its reduced effectiveness.

Source: The Queensland Times, 2nd December 2011.  http://www.qt.com.au/story/2011/12/02/vaccine-a-dud-says-city-doctor/
 Epidemic of Pertussis – Most Children Vaccinated

According to officials in the Hamburg School District, they have an outbreak of pertussis, better known as whooping cough, on their hands.

A letter to parents from Hamburg superintendent Stephen Keifer warns parents there have been “several confirmed cases of pertussis in the school district.”

Keifer told 69 News there have been five cases, four of which were students at the elementary schools.

“That’s not unique,” said Dr. Kenneth De Benedictis, the head of Reading Hospital’s infection control and prevention. “That’s happened before in that population.”

De Benedictis said most children have been vaccinated against pertussis.

“Either it’s worn off or there’s something defective in the vaccine, but it is an effective vaccine basically,” De Benedictis explained.

Source: 69 News, 17th August 2011 – http://www.wfmz.com/news/District-Dealing-With-Outbreak-Of-Whooping-Cough-In-Schools/-/121458/220568/-/141ssff/-/index.html

Three Cases of Pertussis – All were Vaccinated

Three children in the same Grand Island elementary school have been diagnosed with pertussis, more commonly called whooping cough, since last Thursday.

The Central District Health Department issued a whooping cough outbreak advisory this morning.

All three children were current on vaccines, Vap said.

“They all have five doses (of pertussis vaccine), so we are not exactly sure why they contracted the disease,” Vap said.

Source: The Independent, 2nd March 2011

http://www.theindependent.com/news/local/grand-island-has-whooping-cough-outbreak/article_762d224e-2877-51b1-a5b7-8d0e91f1f51f.html

Vaccinated Doctors Get Whooping Cough

Two more Women’s and Children’s Hospital doctors have been confirmed with whooping cough in Adelaide.

There have now been three cases in recent weeks.

Nine adults and 41 babies who were patients at the hospital have been offered antibiotics as a preventative measure.

The hospital says the doctors have contracted the infection despite keeping their vaccinations up to date.

One of the doctors diagnosed over the weekend also worked at North Eastern Community Hospital in Adelaide.

Another 46 patients there have been offered antibiotics.

There has also been a recent infant death in Adelaide from whooping cough.

Source: ABC News, 18th October 2010http://www.abc.net.au/news/2010-10-18/more-kids-hospital-doctors-get-whooping-cough/2301942

Even the Fully Vaccinated Can Still Get Whooping Cough

Those fully vaccinated for whooping cough can still get the disease, says an epidemiologist with the Indiana State Department of Health.

“We do see cases of kids appropriately vaccinated who still get the disease,” said Angie Cierzniewski, a state vaccine preventable disease epidemiologist.

“Some vaccines we think of as rockstars — they work exceptionally well and it’s almost unheard of to get the disease once a person is vaccinated,” she said, giving the example of the vaccine for measles.

The pertussis vaccine “is not a rockstar,” she said. It’s possible to be fully vaccinated and get the disease, she said. Typically, the disease would be less severe if the person is fully vaccinated.

A Clay County woman knows first-hand that a pertussis vaccination doesn’t eliminate the possibility of someone getting pertussis, also known as whooping cough.

The woman, who did not want her name used, said four children in her family became infected with the disease, and the child that first developed it — her 4-year-old — did have the required doses for her age.

She said two of her children had the required number of doses, a 2-year-old was not vaccinated because of low immunity and other reasons and the oldest, an 8-year-old, was lacking one of the required doses of the vaccination.

The primary series of whooping cough vaccinations calls for five doses, recommended at two months, four months, six months, 15 through 18 months and the last one before kindergarten (four to six years of age), Cierzniewski said.

The Clay County woman said health authorities had incorrect information that her children contracted the disease because they were not immunized. She wants people to realize they can contract the disease even if they are immunized. “I feel the public may have a false sense of security,” she said.

None of her children required hospitalization, and the entire family has been treated with antibiotics, she said.

Source: The Tribune Star, 4 December 2010 – http://tribstar.com/news/x1199045212/Even-those-fully-vaccinated-can-still-get-whooping-cough-health-official-says

103 Cases of Whooping Cough – NOT ONE Unvaccinated Person Caught it!

Bass called the outbreak “an extraordinary situation” that began in December and has grown to include more than 103 cases that are either confirmed or probable, with an almost equal number falling into each category.

“It certainly has been a learning curve,” he said. But he and Shapley-Quinn praised the school system, and in particular public information officer Jenny Faulkner, for effectively working with the health department. The school system has worked with the health department to identity “close contacts” of students with confirmed or reportable cases in order to notify families.

Pertussis, or whooping cough, is a bacterial infection of the respiratory tract that can last for many weeks. Symptoms include a runny nose, low fevers, coughing fits and vomiting.

Bass said the system has a “really good vaccination rate,” which “raises questions about the vaccine itself” and its effectiveness in preventing the disease.  He and Shapley-Quinn said it’s likely the Centers for Disease Control will study the situation to examine those questions.

SHAPLEY-QUINN SAID there’s no instance of a child who had not been vaccinated getting pertussis, though the health department is waiting to receive paperwork to confirm for certain one student was up to date on the shots.

After pertussis was found at B. Everett Jordan Elementary School, Shapley-Quinn said, “We gave out 700 courses of preventive antibiotics in that school alone.”

With approval from the CDC, the health department began shifting its approach in an effort to balance disease prevention and overuse of antibiotics, which can weaken resistance of the body’s immune system. Now, families of students considered close contacts of those with confirmed or probable cases of pertussis get a letter that says “If you have a cough, see your doctor” instead of automatically being offered the antibiotics.

Source: The Times News, 14th March 2012.  http://www.thetimesnews.com/news/school-53424-department-health.html

Mother’s Two Vaccinated Kids Get Whooping Cough

A Bunbury mother has put out a call for other parents to not ignore children coughing after her two vaccinated children were diagnosed with whooping cough.

Whooping cough cases have doubled across the South West with 91 cases reported in the first three months of this year.

In Bunbury there have been 14 cases reported, doubling from seven last year.

Stacey Baskerville’s son Finn, 6, and daughter Ruby, 8, were both vaccinated against the illness when they were 18 months old.

But 10 days ago she got a call from a doctor telling her they had both contracted the contagious disease.

‘‘I was just in shock—I couldn’t believe them when they said it was whooping cough,’’ Ms Baskerville said.

‘‘To think that even if you do vaccinate against it you can still get it is scary.’’

Source: The South Western Times, 5th April 2012 – http://au.news.yahoo.com/thewest/regional/southwest/a/-/community/13354759/whooping-cough-outbreak-in-bunbury/

State Ends Free Parent Vaccination Because ‘Cocooning’ is Not Effective

PARENTS across Australia will no longer receive free whooping cough vaccinations because it is not effective in protecting newborns from the potentially deadly illness, a parliamentary committee has heard.

Since 2009 all states and territories except Tasmania have at some stage introduced the free parental vaccination program in an effort to shield infants from the illness.

Whooping cough, a highly infectious airborne bacterial disease, can kill if complications cause lack of oxygen to the brain.

It is most serious in babies under a year old, with newborns susceptible as they are unable to be vaccinated until they are at least four months old.

But at a Victorian Parliamentary Accounts and Estimates Committee hearing on Tuesday, Department of Health divisional executive director Chris Brook said states were abandoning the “cocooning” program from June 30.

He said the national Pharmaceutical Benefits Advisory Committee (PBAC) had determined vaccinating parents was not effective in protecting newborns, after two pharmaceutical manufacturers made submissions to the PBAC.

The PBAC, which is totally independent and very expert, has determined that there is no clinical effectiveness of this strategy,” Professor Brook said.
He said this had made it clear the cocooning strategy should not be continued.

“So all jurisdictions who have been in this program will be effectively ceasing the cocooning strategy as of the end of June this year.”

Source: The Telegraph, 8th May 2012 – http://www.dailytelegraph.com.au/news/breaking-news/states-ending-free-parent-whooping-vaccine/story-e6freuyi-1226350174856

75.8% of People in Pertussis Epidemic Already Fully Vaccinated

Since mid-2011, a substantial rise in pertussis cases has been reported in the state of Washington. In response to this increase, the Washington State Secretary of Health declared a pertussis epidemic on April 3, 2012. By June 16, the reported number of cases in Washington in 2012 had reached 2,520 (37.5 cases per 100,000 residents), a 1,300% increase compared with the same period in 2011 and the highest number of cases reported in any year since 1942. To assess clinical, epidemiologic, and laboratory factors associated with this increase, all pertussis cases reported during January 1–June 16, 2012, were reviewed. Consistent with national trends, high rates of pertussis were observed among infants aged <1 year and children aged 10 years. However, the incidence in adolescents aged 13–14 years also was increased, despite high rates of vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, suggesting early waning of immunity. The focus of prevention and control efforts is the protection of infants and others at greatest risk for severe disease and improving vaccination coverage in adolescents and adults, especially those who are pregnant. Pertussis vaccination remains the single most effective strategy for prevention of infection.

The vaccination status of patients was determined by review of medical records and by patient or parent report. Vaccination was considered up-to-date if the minimum number of doses by age had been received, as recommended by the Advisory Committee on Immunization Practices (2). Patients with invalid dose dates (e.g., date of dose preceding date of birth) were excluded from the vaccination status analysis. Individual doses were excluded if administered <14 days before symptom onset.

Valid vaccination history was available for 1,829 of 2,006 (91.2%) patients aged 3 months–19 years. Overall, 758 of 1,000 (75.8%) patients aged 3 months–10 years were up-to-date with the childhood diphtheria and tetanus toxoids and acellular pertussis (DTaP) doses. Receipt of Tdap was documented in 97 of 225 (43.1%) patients aged 11–12 years and in 466 of 604 (77.2%) patients aged 13–19 years. Estimated DTaP coverage in Washington among children aged 19–35 months was 93.2% for ≥3 doses and 81.9% for ≥4 doses in 2010; Tdap coverage in adolescents aged 13–17 years was estimated at 70.6% (3).

Source: MMWR, July 20, 2012 / 61(28);517-522.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6128a1.htm

Vaccinated Hospital Worker May Have Exposed Hundreds to Pertussis

Providence Hospital officials say one of their own workers may have exposed hundreds of people to whooping cough, and now they’re notifying employees and patients to get help immediately.

Providence Regional Medical Center has been ground zero for the treatment of pertussis, or whooping cough. But this week it became ground zero for a new potential outbreak.

Doctor Ahmet Tural is the head of infectious disease at the hospital. He said a hospital employee went to the staff clinic last week complaining of a nasty cough. He was sent home as a precaution, and on Monday his test results came back positive for whooping cough.

“He probably had it for about two weeks or slightly more, perhaps,” Tural said.

That means the employee had two weeks of direct contact with patients and fellow employees at the hospital. Officials believe at least 53 employees have been exposed to the illness, but that number could end up being more than 300 after factoring in patients and visitors.

The hospital has been proactive.

“If they had direct exposure, then we automatically require them to be put on antibiotics,” said Providence official Teresa Wenta.

The worker in question thought he had been proactive, too. He was vaccinated against pertussis, but it wasn’t effective.

Tural said sometimes the vaccination just doesn’t work.

“In 20, 25, 30 percent of the cases it may not be fully protective,” he said.

Source: Komo News, 4th July 2012.  http://www.komonews.com/news/local/161381365.html

Pertussis Vaccine Doesn’t Work Over Time

The protection provided by acellular pertussis vaccines (DTaP) as a first dose may fall short of that provided by first-dose whole-cell pertussis vaccines (DTwP), which were phased out in the 1990s because of higher rates of adverse events, an Australian study showed.

Among children born in 1998, rates of pertussis were higher among those who received an acellular vaccine instead of a whole-cell vaccine for the first three doses in the primary series, according to Sarah Sheridan, BMed, of Queensland Children’s Medical Research Institute in Brisbane, Australia, and colleagues.

The difference was evident during a pre-epidemic period from 1999 to 2008 and during a period of elevated pertussis rates from 2009 to 2011, they reported in a research letter in the Aug. 1 issue of the Journal of the American Medical Association.

“The challenge for future pertussis vaccine development is to address the benefit-risk trade-off highlighted by our study,” they wrote, “and to develop vaccines that induce long-lasting protection from the first dose, without the adverse events associated with DTwP use.

Similar to what has been occurring in the U.S., Australia has seen increasing rates of pertussis in the last few years. Sheridan and colleagues explored whether the rise could be related to the switch from one vaccine type to the other.

Of 58,233 children born in 1998, 69.5% received at least three doses of any pertussis vaccine during the first 6 months of life. Among the vaccinated children, there were 267 first pertussis cases reported through 2011.

Children who received the three-dose primary series with DTaP only had higher rates of pertussis compared with those who received the primary with DTwP only, both during the pre-epidemic period (13.2 versus 5.2 per 100,000 per year) and the outbreak period (373.1 versus 113.3 per 100,000 per year).

For children who received a mix of both types of vaccine, rates of pertussis were higher during the outbreak period for those who received DTaP as the first dose (409.0 versus 113.3 per 100,000 per year).

It is possible, they noted, that the higher rates of disease with the acellular vaccine could be related to changes in the circulating Bordetella pertussis strains or differences in the immune responses induced by the two types of vaccine.

Source: Medpage Today, 31st July 2012 – http://www.medpagetoday.com/InfectiousDisease/URItheFlu/33998

Marked Acellular Pertussis Vaccine Failure in 8-14 Year-olds in a North American Outbreak

Background: Despite widespread vaccination against Bordetella pertussis, disease remains prevalent. Acellular Pertussis vaccine may be less effective or durable than previously believed. Its clinical efficacy has yet to be evaluated in North America. At the epicenter of the largest outbreak in decades, we examined pertussis incidence and vaccine efficacy in a well-defined, vaccinated community. Methods: We reviewed 171 patients with a positive PCR for B. pertussis from March 1 to October 31, 2010 for demographics and vaccination status. Results: We found 132 cases of clinical pertussis in patients age <19, with peak incidence in ages 8-14. Testing rate peaked in infants, but remained nearly constant in other ages. The case rate markedly increased after age 7, peaking at age 12 and appeared to correlate to an increased interval since vaccination. Unvaccinated children accounted for very few cases. Conclusions: The 2010 pertussis outbreak was an excellent natural experiment to assess the American acellular pertussis vaccine. In a well-defined population with excellent ascertainment, minimized selection bias and known vaccination status, acellular boosters appear to be ineffective after 3 years. The sustaining population of the outbreak was fully immunized by national guidelines but more than 2.5 years since their last booster. Acellular pertussis boosters are effective but less durable than previously thought. Vaccine guidelines and pertussis control measures need to be reconsidered.

Source: M. A. Witt – Res. Assistant, P. H. Katz, MD, MPH – Senior Pediatrician, D. J. Witt, MD – Chief, Infectious Diseases;
Kaiser Permanente Med. Ctr., San Rafael, CA.  http://www.abstractsonline.com/Plan/ViewAbstract.aspx?mID=2789&cKey=223c57e0-0217-4327-aa94-9677ed5ea4c4&sKey=4451459e-9f2b-4cb4-af74-27104aa3d756

Fully Vaccinated Johnson Crossing student diagnosed with whooping cough

Johnson Crossing Academic Center is undergoing a thorough cleaning this weekend after one student was diagnosed with pertussis, also known as whooping cough.

We had a student that, unfortunately, didn’t stay out of the school,” said Brandi Tumbleson, executive director of Three Rivers District Health Department. “Normally it’s a recommendation that if they test positive for pertussis, they’re out of school until they’ve been on antibiotics for five days. He was in school previous to being tested (last) weekend, and he’s been in school all week.”

The odd thing about this case, she said, is the student had been vaccinated in 2006 and was current on his vaccination schedule.

“That’s what’s frustrating with this,” she said. “I don’t know if the vaccine just wore off; some public experts have been saying it does wear off, but what’s frustrating is we know it can work and that’s why we want people to be vaccinated. However, certain states have had big rushes of it and we’re seeing a rush here in this area.”

Source: Fremont Tribune, 24 August 2012 – http://fremonttribune.com/news/local/johnson-crossing-student-diagnosed-with-whooping-cough/article_580f8724-ee48-11e1-b11a-0019bb2963f4.html?comment_form=true

VAN UK’s Comment: Yes, so effective. The child was fully vaccinated, perhaps it wears off, it can work so vaccinate except there are big rushes of whooping cough in this area. What!? So many contradictions.

Outbreak study details waning protection from pertussis vaccine

A detailed look at California children during the state’s large pertussis outbreak in 2010 revealed that protection from the diphtheria, tetanus, and pertussis (DTaP) vaccine wanes 5 years after kids receive their last dose, which could be fueling outbreaks.

The findings come on the heels of a warning earlier this summer from the US Centers for Disease Control and Prevention (CDC). The agency, along with state health department partners, found an unusual illness spike in Washington state 13- and 14-year-olds, which also raised the possibility of waning pertussis (whooping cough) vaccine protection.

The United States is headed toward its worst pertussis year in decades, CDC officials said in July, and two states—Washington and Colorado—have declared epidemics.

The new study on pertussis in California children, published today in the New England Journal of Medicine (NEJM), is the first to focus on the cohort of children who have received only the DTaP since birth.

In the late 1990s the United States transitioned from a whole-cell pertussis vaccine to an acellular version, due to a fairly high rate of minor side effects with the older vaccine.

The large size of California’s pertussis outbreak allowed researchers at Kaiser Permanente Vaccine Study Center (KPVSC) to examine the relationship between the time since pertussis vaccination and how likely children were to test positive for the disease. The CDC recommends five DTaP doses for children, given at 2, 4, and 6 months; at 15 to 18 months; and when the youngster enters school, between 4 and 6 years of age.

The study focused on Kaiser Permanente’s northern California population, which includes 3.3 million members in a system that has electronic medical records and a central laboratory. It compared 277 children between ages 4 and 12 years who tested positive for pertussis with 3,318 kids who tested negative, with a separate comparison involving 6,086 matched controls.

The researchers analyzed the risk of pertussis in California children from 2006 to 2011 in relation to the time since their last dose of DTaP vaccine, finding that protection wanes 42% each year after the fifth dose (odds ratio of 1.42 [95% confidence interval, 1.21 to 1.66]).

The amount of protection that remained after 5 years depended on the initial effectiveness of the vaccine, according to the study. For example, if the initial effectiveness was 90%, it would drop to 42% after 5 years.

Pertussis incidence was highest in kids ages 8 to 11 years, suggesting that the drop-off in efficacy after the fifth dose in schoolchildren played a role in fueling and sustaining California’s pertussis outbreak. Investigators wrote that this observation was surprising, because teenagers are typically considered a pertussis reservoir and have been disproportionately affected in previous outbreaks.

They noted that the sharp increase in 8- to 11-year-olds, followed by a sharp pertussis drop in 12- to 15-year-olds, hasn’t been seen in the epidemiology of unvaccinated people in previous outbreaks.

Nicola Klein, MD, PhD, who led the study and co-directs the KPVSC, said in a Kaiser Permanente press release that the findings suggest that pertussis control measures may need to be reconsidered.

“Prevention of future outbreaks may be best achieved by developing new pertussis-containing vaccines or reformulating current vaccines to provide long-lasting immunity,” she said. However, Klein emphasized that the DTaP is effective and is still an important tool for protecting children and communities. “Following current CDC recommendations remains important,” She said.

Tom Clark, MD, MPH, a medical epidemiologist with the CDC’s Meningitis and Vaccine Preventable Diseases Branch, told CIDRAP News that researchers have already illustrated the waning protection from an epidemiologic perspective, and now this study and others soon to be published are measuring the degree of risk from the reduced vaccine effectiveness.

Clark coauthored a July report in Morbidity and Mortality Weekly Report (MMWR) that highlighted the illness spike in 13- and 14-year-olds in Washington’s recent outbreak

Health officials are also seeing waning protecting with the tetanus, diphtheria, and pertussis (Tdap) booster recommended for 11-year-old children, he said, adding that protection gaps from both vaccines appear to be fueling the current epidemic.

The nation’s number of pertussis cases reported so far this year—27,726—has surpassed the final number of 27,550 reported for 2010, making 2012 the hardest-hit year in decades, Clark said. The updated pertussis total appears in today’s issue of MMWR.

Scientists don’t have a clear understanding of why the vaccine doesn’t protect very well, and developing a better vaccine could be a long way off, because there’s not much in the pipeline, Clark said. “A lot of us are saying ‘start now,’ ” he added.

In the meanwhile, pertussis vaccination is still the best way to fight the disease and is still a very important tool, especially since there is a lot of ongoing pertussis activity, he said.

Michele Roberts, MPH, with the Washington State Department of Health immunization program, has been involved with the state’s epidemiologic investigations of pertussis activity and took note of the new NEJM findings. She said the vaccine protection drop-off the Kaiser team found is another piece of the puzzle that will help experts better understand how to use the vaccine to control outbreaks.

She said the next step is to evaluate the duration of protection from the Tdap vaccine, adding that studies are already under way to shed light on that issue. Pertussis is a difficult disease to understand, Roberts said, because natural infection doesn’t provide long-term immunity, and there are still several unanswered scientific questions.

Roberts echoed the point that health officials are still embracing use of the vaccine. She said its short-term protection is good and it is useful for helping prevent the spread of the disease, especially in outbreak settings, and to mitigate the severity of infections.

Klein NP, Bartlett J, Rowhani-Rahbar A, et al. Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med 2012 (published online Sep 13) [Abstract]

Source: CIDRAP, 13th September 2012.  http://www.cidrap.umn.edu/cidrap/content/other/news/sep1312pertussis.html

All Four Mahomet Children with Whooping Cough were Vaccinated

All four children sickened last month by whooping cough in Mahomet had been vaccinated for the disease, a public health official said.

The four children, two at Lincoln Trail Elementary School and two at Mahomet Junior High School, got sick in November, with the latest case lab-confirmed Tuesday, said Rachella Thompson, communicable disease investigator for the Champaign-Urbana Public Health District.

One of the Mahomet youths had severe symptoms, but didn’t require hospitalization, she said. For the others, the symptoms were mild.

The disease starts out like a cold with a runny nose, but gradually progresses to violent coughing spasms and sometimes comes with a low-grade fever, Thompson said.

The treatment is being confined at home for five days on antibiotics, she said.

Source: The News Gazette, 6th December 2012 – http://www.news-gazette.com/news/health/health-care/2012-12-06/mahomet-children-whooping-cough-had-been-vaccinated-booster-urged

Whooping cough outbreak hits northern Utah

Weber-Morgan Health Department officials are working with parents and teachers to contain the contagious bacterial disease, also known as pertussis, which is circulating in several schools in Weber County.

One infant has been hospitalized and five others are experiencing symptoms. The number of individuals involved in the investigation has risen to more than 30, including family members and students who attend Wahlquist Junior High, Plain City Elementary and Evergreen Montessori Academy. School officials sent letters alerting parents earlier this week.

So far this year there have been 68 cases in Utah, and last year 1,183 cases were reported. That’s down from 2012, when Utah’s whooping cough cases reached 1,544, rivaling the pre-vaccination-era levels of the 1940s.

Some among those exhibiting symptoms in Weber County were fully immunized and some weren’t.

A recent study found that the DTaP vaccine may not be as effective as previously thought. It appears to wear off after the fifth dose, which is given between the ages of 4 and 6, making older children more vulnerable, according to the New England Journal of Medicine.

For this reason, the U.S. Centers for Disease Control and Prevention (CDC) recommends booster shots for incoming seventh-graders — and for adults as well. Mothers are told to get vaccinated with each pregnancy, and caregivers of infants.

Source: The Salt Lake Tribune, 28 February 2014.

VAN UK’s Comment: They say you need 5 doses to be protected, yet it ‘wears off’ after 5 and you need more through your childhood and adulthood so although they don’t work you have to keep taking more and more! (How to make $ out of a useless product).

Despite vaccine, pertussis spreads

A government study offers a new theory on why the whooping cough vaccine doesn’t seem to be working as well as expected.

The research suggests that while the vaccine may keep people from getting sick, it doesn’t prevent them from spreading whooping cough – also known as pertussis – to others.

“It could explain the increase in pertussis that we’re seeing in the U.S.,” said one of the researchers, Tod Merkel of the Food and Drug Administration.

Whooping cough is a highly contagious disease that can strike people of any age but is most dangerous to children. It was once common, causing hundreds of thousands of illnesses annually and thousands of deaths. But after a vaccine was introduced in the 1940s, cases dropped to fewer than 5,000 a year.

The vaccine was replaced in the 1990s because of side effects that included pain and swelling from the shot and fever. The newer vaccine is part of routine childhood vaccinations as well as adult booster shots.

But cases have rebounded. Last year was the nation’s worst year for whooping cough in six decades- U.S. health officials received reports of more than 48,000 cases, including 18 deaths.

This year hasn’t been half as bad – about 20,000 reported illnesses, including six deaths so far.

Some studies have concluded the newer vaccine doesn’t last as long as the old one. But the study by Dr. Merkel offers a new wrinkle.

Their research used baboons, considered the most human-like model for studying whooping cough. Baboons at ages 2, 4 and 6 months were vaccinated and then exposed to whooping cough at 7 months – when vaccine protection would be new and strong.

The baboons didn’t get sick, but they had high levels of bacteria in their respiratory system for five weeks – which suggest they were contagious for about that long. Some baboons given the old vaccine had low levels after only two weeks.

Source: The Times Tribune, 26 November 2013 – http://thetimes-tribune.com/news/health-science/despite-vaccine-pertussis-spreads-1.1591349

Whooping Cough Vaccine Doesn’t Work: Even after Multiple Doses, Children Aren’t Immune at Age 2

The bacteria that causes deadly whooping cough has mutated to more easily evade its vaccine, potentially putting hundreds of thousands of children at risk.

Experts fear a new booster shot may be needed for 18-month-olds, and say it is more important than ever that babies are immunised as early as possible to prevent exposure from people whose vaccines have worn off.

A study by NSW researchers has found almost 80 per cent of whooping cough cases analysed were caused by a mutated bacteria that had stopped producing pertactin – one of the three key proteins targeted by the vaccine.

“Clearly it is a red light in terms of how well the vaccination works,” said Peter McIntyre, study author and director of the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases.

The number of whooping cough cases in Australia has more than doubled since 1994, reaching a peak of 38,000 people diagnosed at the height of the epidemic in 2011.

Professor McIntyre said while overall cases were down this year, there was a substantial increase in two- to four-year-olds diagnosed in the past five years.

“We are seeing a lot more cases in older immunised kids which is very concerning if those children have younger siblings … It could be because we are better at finding it but there seem to be issues in children after [they] turn two.”

The study, published in Emerging Infectious Disease, analysed 320 samples of Bordetella pertussis bacteria from patients with whooping cough from 2008 to 2012, with the proportion of pertactin-free bacteria jumping from 5 per cent in 2008 to 78 per cent in 2012.

Lead author Connie Lam said the “huge increase” in mutated bacteria, which has also been found in the US and France, was unexpected.

“The fact that they have arisen independently in different countries suggests it’s a response to the vaccine,” said Ms Lam, of the University of NSW school of biotechnology and biomolecular sciences.

“It could also mean that these pertactin-free strains have gained a selective advantage over other bacteria, making it less obvious for the body to find and destroy.”

The major problem with the current “acellular” vaccine – which has less side-effects than the former whole cell version – is there are only three components, he said, “so if one of them is waning then you haven’t got a lot to fall back on”.

Martinez family copes with whooping cough despite vaccinations

A Martinez family was shocked to get the news that their two young children tested positive for pertussis, commonly called whooping cough, despite having been vaccinated and receiving booster shots.

The 9-year old boy goes to Morello Elementary in Martinez. The principal sent an email to parents warning them of the student’s case that was reported to the Contra Costa County Health Department.

His parents reached out to KTVU, saying they wanted to let others know they did their due diligence vaccinating their children, ages 9 and 3. They also wanted to warn other parents the vaccine might not be enough to protect their kids.

“We all had DTaP, we all had the boosters, and we all still got whooping cough.” the mother told KTVU from her home. She wanted to keep the family’s identity secret. “They had a low grade fever and this just seemed like another cold,” she said.

After repeated visits to the doctor’s office, she asked for a pertussis test. “I said just swab them so we can eliminate it.” The test came back positive.

In the 1990’s the vaccine for pertussis changed in an effort to eliminate some of the side effects in children. Research shows it also seems to have eliminated some of the vaccine’s effectiveness.

Doctors working on vaccines at Kaiser Permanente’s Research Division in Oakland said findings of a study of DTaP effectiveness over time “…suggest that whooping cough control measures may need to be reconsidered. Prevention of future outbreaks may be best achieved by developing new pertussis-containing vaccines or reformulating current vaccines to provide long-lasting immunity.”

The family in Martinez is in the last stages of the disease. Their children finished their courses of medicine, so they are no longer contagious, though the coughing persists. So do the sleepless nights.

“There’s no one to blame.” She told KTVU. “What needs to be done is get another vaccination ready so that nobody has to go through this, ever.”

Source: KTVU, 24 April 2014 – http://www.ktvu.com/news/news/health-med-fit-science/martinez-family-copes-whooping-cough-despite-vacci/nfhPj/

Yolo County Officials Perplexed By Unusual Spike In Whooping Cough Cases: 95% of Cases are in the Vaccinated

Little Rebecca Hall hasn’t had so much as a fever in her 14 months of life. Her mom Nakayla says it’s because she’s been diligent with her daughter’s immunization schedule.

“It’s completely important. she’s gotten all of her vaccinations and she hasn’t been sick once,” she said.

But health officials are concerned, because Yolo County is seeing a spike in whooping cough cases stronger than the rise in other California counties.

“It’s most concerning because infants can become seriously ill and die from pertussis,” said Dr. Constance Caldwell with the Yolo County Health Department.

She’s puzzled by the spike, because nearly 95 percent of kids in Yolo County public schools are vaccinated.

“We have not seen the dramatic decline in the use of vaccine in this county that some other counties have seen,” she said.

Source: CBS Sacramento, 14th July 2014 – http://sacramento.cbslocal.com/2014/07/14/yolo-county-officials-perplexed-by-unusual-spike-in-whooping-cough-cases/

Whooping cough in school age children presenting with persistent cough in UK primary care after introduction of the preschool pertussis booster vaccination: prospective cohort study

Abstract

Objective To estimate the prevalence and clinical severity of whooping cough (pertussis) in school age children presenting with persistent cough in primary care since the introduction and implementation of the preschool pertussis booster vaccination.

Design Prospective cohort study (November 2010 to December 2012).

Setting General practices in Thames Valley, UK.

Participants 279 children aged 5 to 15 years who presented in primary care with a persistent cough of two to eight weeks’ duration. Exclusion criteria were cough likely to be caused by a serious underlying medical condition, known immunodeficiency or immunocompromise, participation in another clinical research study, and preschool pertussis booster vaccination received less than one year previously.

Main outcome measures Evidence of recent pertussis infection based on an oral fluid anti-pertussis toxin IgG titre of at least 70 arbitrary units. Cough frequency was measured in six children with laboratory confirmed pertussis.

Results 56 (20%, 95% confidence interval 16% to 25%) children had evidence of recent pertussis infection, including 39 (18%, 13% to 24%) of 215 children who had been fully vaccinated. The risk of pertussis was more than three times higher (21/53; 40%, 26% to 54%) in children who had received the preschool pertussis booster vaccination seven years or more previously than in those who had received it less than seven years previously (20/171; 12%, 7% to 17%). The risk of pertussis was similar between children who received five and three component preschool pertussis booster vaccines (risk ratio for five component vaccine 1.14, 0.64 to 2.03). Four of six children in whom cough frequency was measured coughed more than 400 times in 24 hours.

Conclusions Pertussis can still be found in a fifth of school age children who present in primary care with persistent cough and can cause clinically significant cough in fully vaccinated children. These findings will help to inform consideration of the need for an adolescent pertussis booster vaccination in the United Kingdom.

Source: British Medical Journal: BMJ 2014;348:g3668

This very interesting study states that 37% of UK school children presenting with persistent cough have whooping cough.

Resurgence of Pertussis: Vaccinated People at Higher Risk of Whooping Cough

As reported at the May 2013 BSC meeting, the recent resurgence in pertussis cases has been associated with waning immunity over time in persons who received the acellular pertussis vaccine (which is administered as the pertussis component of DTaP vaccine). However, a recent study suggests another explanation for decreased vaccine effectiveness: an increase in Bordetella pertussis isolates that lack pertactin (PRN)–a key antigen component of the acellular pertussis vaccine. A study that screened B. pertussis strains isolated between 1935 and 2012 for gene insertions that prevent production of PRN found significant increases in PRN-deficient isolates throughout the United States.2 The earliest PRN-deficient strain was isolated in 1994; by 2012, the percentage of PRN-deficient isolates was more than 50%. 2Pawloski LC, Queenan AM, Cassiday PK, et al. Prevalence and molecular characterization of pertactin-deficient Bordetella pertussis in the United States. Clin Vaccine Immunol 2014;21(2):119-25. To assess the clinical significance of these findings, CDC used an IgG anti-PRN ELISA and other assays (PCR amplification, sequencing, and Western blots) to characterize 752 B. pertussis strains isolated in 2012 from six Enhanced Pertussis Surveillance Sites3 and from epidemics in Washington and Vermont. Findings indicated that 85% of the isolates were PRN-deficient and vaccinated patients had significantly higher odds than unvaccinated patients of being infected with PRN-deficient strains. Moreover, when patients with up-to-date DTaP vaccinations were compared to unvaccinated patients, the odds of being infected with PRN-deficient strains increased, suggesting that PRN-bacteria may have a selective advantage in infecting DTaP-vaccinated persons.

Source:

http://www.cdc.gov/maso/facm/pdfs/BSCOID/2013121112_BSCOID_Minutes.pdf

Once almost eradicated, whooping cough surges back

Heather Petersons listened to her 5-year-old daughter, Camille, and worried.

“She would cough and cough and cough and then she would be gasping to take a breath,” Petersons recalled. “Her eyes would be watering from coughing. The coughing wiped her out.”

But April 2012 was a busy time for the Milwaukee family, and it was probably just a bad cold. Camille kept going to her kindergarten class at St. Dominic Catholic School. The family held an adoption party for her new younger sister and invited about 20 people. All the while, Camille could not shake her cough.

It got so bad Petersons videotaped her daughter before heading to the family doctor, just in case the child stopped coughing the moment they entered the exam room. The doctor took a swab for testing and called back a few hours later. Camille had pertussis, whooping cough. She had caught the disease even though she’d been vaccinated against it.

Source: Milwaukee Wisconsin Journal Sentinel, 31st January 2015, http://www.jsonline.com/news/health/once-almost-eradicated-whooping-cough-surges-back-b99433928z1-290458001.html

Pertussis outbreak at Salinas school with 99.5% Vaccination Rate

In less than one month, four students at Monterey Park School have been diagnosed with pertussis, or whooping cough.

Principal Brian Hayes and school officials met with parents to offer information and answer questions.

“There really hasn’t been a feeling of fear. It’s been more of ‘what can we do to stop this?'” he said.

The first case was diagnosed on Feb. 25. Three more students from the same fifth grade class also came down with the disease.

“If there are students who are sick, we’re taking temperatures, we’re notifying parents. If they need to go to a physician, we’re doing that,” Director of Pupil Personnel Services Beatriz Chaidez said.

“Libraries, computer labs, the cafeteria, all those areas are getting extra cleaning attention at night,” Hayes said.

Pediatrician Michele Tamse said it can be scary during cold and flu season because at first it’s hard to tell the difference between pertussis and the common cold.

“It can be as simple as the common cold initially, but if we start seeing any signs of vomiting or seizures and blueness to the face, then we have to keep that in mind,” Tamse said.

School officials said of the 524 students at Monterey Park, 99.5 percent are vaccinated, including the four students who have been diagnosed.

All four have completed their five-day anti-biotic treatment at home and are back at school.

Source: KSBW News, 19 March 2015.

http://www.ksbw.com/news/pertussis-outbreak-at-monterey-park-school/31881324

VAN UK’s Comment: Despite the fact that all four of those with whooping cough had been vaccinated and NO unvaccinated child caught it, they suggest vaccinating to solve the problem!

“Parents are wondering, why is my child getting pertussis when I’ve had the immunization?”

The Summit County Health Department is alerting parents about a pertussis outbreak.

Parents with kids in the Park City School District recently received a letter or an email about the health concern, which included facts about the highly contagious respiratory infection.

“I’m getting a lot of phone calls from concerned parents,” said Carolyn Rose, the health department’s nursing director.

Rose said three elementary school-age children initially tested positive for whooping cough last week. That number had grown to 11 Wednesday, she said, and parents are concerned because the kids who were infected were fully vaccinated.

“Parents are wondering, why is my child getting pertussis when I’ve had the immunization?” Rose said.

The problem lies in the fact that pertussis vaccine protection starts to wane five or more years after the first dose.

Source: KSL, 25 March 2015

VAN UK’s Comment: This news report then goes on to say that if the kids hadn’t been vaccinated they would have had severe symptoms and therefore it was evidence the vaccine worked, despite the fact they have NO evidence this is the case, the vaccinated children had pertussis and in a prior report the 0.5% of unvaccinated children didn’t even get the disease!

http://www.ksl.com/?nid=148&sid=33976026

 Cases of whooping cough on the rise in the Fraser Valley

The Fraser Valley is seeing an uptick in the number of whooping cough cases, especially in kids who have been vaccinated. Doctors and parents are being warned.

The illness, which can be fatal in young babies, is appearing in larger numbers. The cases are popping up in group settings like at daycares, in families and at schools.

Medical health officer Dr. Michelle Murti says they’re seeing more cases in vaccinated kids. The pertussis vaccine doesn’t last as long as other types. “Children who are more in the grade seven and eight range who haven’t yet come up to the grade nine booster who are starting to get pertussis activity in those age ranges because the effects of the vaccine are kind of waning. Their last booster was in the kindergarten age group and they haven’t yet come up to the grade nine booster.”

She adds that symptoms in this group tend to be milder so some of the more characteristic symptoms might not be there.

She says they’ve been reaching out to doctors. “We provided at least two reminders to physicians in the community within Fraser Health over the past couple months when we’ve been seeing this increased activity to let them know that yes, we have been seeing increased activity, what that looks like, reminding them about this milder presentation, especially for immunized children, what the appropriate testing is, what the appropriate treatment is as well as the contact follow up.”

Source: News 1130, 18 September 2015

Whooping Cough in Vaccinated Children

B. pertussis resurgence may be due to asymptomatic, vaccinated carriers

The recent resurgence in cases of Bordetella pertussis, or whooping cough, may be caused by vaccinated people who are infectious but do not display symptoms, according to recent study data in BMC Medicine.

An acellular B. pertussis vaccine which blocks symptomatic disease but not asymptomatic transmission is able to account for the observed increase in B. pertussis incidence; complicates situational awareness surrounding levels of current B. pertussis transmission; and potentially biases estimates of vaccine efficacy obtained from case data,” study researchers Benjamin M. Althouse, PhD, ScM, and Samuel V. Scarpino, PhD,both of Santa Fe Institute, wrote.

The researchers analyzed the incident rate of B. pertussis in the United States and United Kingdom. They compared this data with analysis of 36 genome sequence isolates of B. pertussis, gathered between 1935 and 2005, to support evidence of asymptomatic transmission.

Results showed that the timing of age-specific infection rates were consistent with asymptomatic transmission. Asymptomatic transmission also was apparent in the observed cases because the genetic diversity of the bacterial population was too high for the rate of symptomatic infections.

“There could be millions of people out there with just a minor cough or no cough spreading this potentially fatal disease without knowing it,” Althouse said in a press release. “The public health community should act now to better assess the true burden of pertussis infection.”

The investigators said vaccinating individuals in proximity to patients too young for vaccination may be ineffective based on these findings. They suggested further research is required to determine the genetic diversity of B. pertussis and the incident rate of unvaccinated individuals.

“In light of current evidence and our results, we cannot dismiss the potential far-reaching epidemiological consequences of asymptomatic transmission of B. pertussis and an ineffective B. pertussis vaccine,” the researchers wrote. – by David Costill.

Source:

Althouse BM, et al. BMC Med. 2015;doi:10.1186/s12916-015-0382-8.

Unrecognized pertussis infection in adolescents

Little information is available regarding the level of immunity to Bordetella pertussis among adolescents. We measured serum antibodies in 156 healthy adolescents to the following pertussis antigens: pertussis toxin, filamentous hemagglutinin, and 69-kd outer membrane protein. In an attempt to identify intercurrent pertussis infections, we also obtained a total of 43 repeated samples during the following 5 years. Using a 50% or greater rise in IgG enzyme-linked immunosorbent assay titers to define seroconversion, we found an annual incidence of 6.1%; by alternative definitions of seropositivity, the predicted annual incidence of infection ranged from 1.2% to 8.2%. These data suggest that infection with B pertussis is common in the adolescent population.

Source: Am J Dis Child. 1993 May;147(5):575-7.

 26 Vaccinated Preschoolers and 13 Teachers Get Whooping Cough

Twenty-six preschoolers in Leon County, Fla., became ill with pertussis or pertussis-like symptoms — even though many were current on their vaccinations — after a classmate developed the illness, according to a study published by the CDC.

Officials attributed this outbreak to a combination of the children’s incomplete vaccination status, waning immunity due to vaccine type, possible provider error, and perhaps the emergence of vaccine-resistant bacteria.

Another 13 cases were identified among staff members at the preschool, household contacts of the sick preschoolers, and camp counselors who came into contact with a sibling of an ill child.

Among the 33 children (including household contacts) who developed pertussis, 28 had received at least three pertussis vaccinations and 23 had received four or more. Matthias and colleagues estimated the vaccine effectiveness at 45.0%, though with an extremely broad 95% confidence interval (-70.4% to 82.2%).

Scientists writing about the outbreak attempt to save the reputation of the pertussis vaccine by saying that there were more hospitalisations were lower in the group up-to-date on their vaccines.  However, three were babies two young for three doses and were at an age when whooping cough is known to be more severe and another child was fully vaccinated. Only one was on a delayed schedule but had still been partially vaccinated.

In the classroom with the highest attack rate (48%), all 17 students had been fully vaccinated for their age range.

Source: Medpage Today, 13th January 2016 and commentary by Joanna Karpasea-Jones of VAN UK.

Pertussis Attack Rate Highest in Fully Vaccinated Kids

Increasing incidence of pertussis in Brazil: a retrospective study using surveillance data – 23.1% of cases had 3 doses of DTaP

Abstract

BACKGROUND:

Many countries have reported an increase in the incidence of pertussis, which has become a global public health concern.

METHODS:

In this study, the epidemiology of pertussis in Brazil was assessed retrospectively using surveillance data gathered from case notification forms from 2007 to 2014.

RESULTS:

From 2007 to 2014, 80,068 suspected cases of pertussis were reported in Brazil. Of these, 24,612 (32 %) were confirmed by various criteria. The annual distribution of confirmed cases demonstrated a significant increase in incidence rate since 2012. A seasonal pattern in which cases occur most frequently between the end of spring and midsummer has been identified. Among the confirmed cases, 34.5 % occurred in infants aged 0-2 months, 22.4 % occurred in infants aged 3-6 months, 21 % occurred in children aged 7 months to 4 years, and 8 % were reported in adults >21 years. Of the confirmed cases, 47.2 % met only clinical criteria, 15.5 % met clinical and epidemiological criteria, and 36.6 % were confirmed in a laboratory. The overall case fatality rate was 2.1 %, reaching 4.7 % among infants aged 0-2 months. The complications most commonly reported in the notification forms were pneumonia, encephalitis, dehydration, otitis, and malnutrition. Of the confirmed cases, 23.1 % occurred in subjects who received at least 3 doses of the pertussis vaccine. Within this group, there were 1098 infants aged 7 to 15 months and 2079 children aged 16 months to 4 years. In 2012, 18 states did not achieve 95 % immunization coverage, a number that dropped to 10 and 6 in 2013 and 2014, respectively.

CONCLUSIONS:

Brazil’s main challenges in facing pertussis resurgence will be to offer the best quality medical attention to reduce mortality, to improve the infrastructure for laboratory diagnosis and to increase vaccination coverage. Additional studies to assess the effectiveness of the current vaccination schedule and basic research on the genetics and evolution of circulating B. pertussis strains are also needed.

Source: BMC Infect Dis. 2015 Oct 23;15:442. doi: 10.1186/s12879-015-1222-3

Effectiveness of Whooping Cough Booster Leaves Lot to Be Desired

Whooping cough outbreaks in a various states over recent years have called into question the effectiveness of both the initial vaccines and the boosters used to prevent the condition in young children and teens. Evidence now suggests that as suspected, the booster kids receive in order to provide protection during their teenage years may be fundamentally flawed.

If new research proves accurate, effectiveness of the most commonly used whooping cough booster vaccine drops by a full 35% every year.

Focusing on a group of around 280,000 California teens among which 1,200 cases of whopping cough were diagnosed between 2006 and 2015, the researchers concluded that high vaccination rates may not in fact be as effective as previously thought.

In the first 12-months following the vaccination – also known as TDAP – whopping cough prevention rates were recorded at 69%. However, four years after the booster the study found that effectiveness rates plummeted to just 9%.

Source: Modern Readers, 7th February 2016.

Whooping Cough Vaccine only 9% Effective after 4 Years

King student with Whooping Cough had been vaccinated

Corpus Christi ISD confirms a King High School student diagnosed with whooping cough on Friday had been vaccinated for the disease.

Infection among the vaccinated is rare, but not unheard of.

Most whooping cough cases occur either in infants too young to have completed the vaccination series or among teenagers and young adults whose immunity has faded since they were vaccinated.

Source: 6KrisTV.com, 3rd February 2016.

King student with Whooping Cough had been vaccinated

Tdap vaccine moderately effective for 1 year after vaccination

n adolescents who have received DTaP vaccines as infants, the Tdap vaccine offers moderate protection against whooping cough during the 1st year after vaccination, but effectiveness decreases to less than 9% after 4 years, according to a study published in Pediatrics.

During the 1990s, clinicians in the United States started vaccinating children with DTaP (diphtheria, tetanus, and pertussis) vaccines, replacing the older whole cell pertussis (DTwP) vaccine used previously. Despite high rates of vaccine coverage, the number of whooping cough cases in the United States and other countries has increased since the switch.

To combat the rise in whooping cough, the Advisory Committee on Immunization Practices recommended that all adolescents aged 11 to 12 years get a booster Tdap vaccine, starting in 2006.

To explore the Tdap (tetanus-diphtheria-acellular pertussis) vaccine’s efficacy during outbreaks, the study included only adolescents vaccinated with Tdap who received the DTaP vaccine for all 5 rounds of childhood immunization, specifically focusing on the 2010 and 2014 outbreaks of whooping cough in Northern California.

Using 1,207 pertussis cases, the researchers found that Tdap vaccine efficacy was 68.8% during the 1st year after vaccination. The efficacy rate decreased to 8.9% 4 or more years after vaccination. During the 2014 outbreak, adolescents had the highest incidence of pertussis in any age group despite greater than 90% vaccine coverage among them.

“This study demonstrates that despite high rates of Tdap vaccination, the growing number of adolescents who have received only the newer acellular pertussis vaccines continue to be at higher risk of contracting whooping cough and sustaining epidemics,” said Nicola Klein, MD, PhD, co-director of the Kaiser Permanente Vaccine Study Center. “Because Tdap provides reasonable short-term protection, it may contain whooping cough more effectively if it is administered to adolescents in anticipation of a local outbreak rather than on a routine basis at age 11 or 12.”

Source: Clinical Advisor, 6th February 2016.

Tdap vaccine moderately effective for 1 year after vaccination

Waning Tdap Effectiveness in Adolescents

Routine Tdap did not prevent pertussis outbreaks. Among adolescents who have only received DTaP vaccines in childhood, Tdap provided moderate protection against pertussis during the first year and then waned rapidly so that litle protection remained 2-3 years after vaccination..

Source: Klein NP, Bartlett J, Fireman B, et al. Waning Tdap Effectiveness in Adolescents. Pediatrics. 2016; doi:10.1542/peds.2015.3326.

Why Are We Seeing So Much Pertussis?

Impact of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccinations on Reported Pertussis Cases Among Those 11 to 18 Years of Age in an Era of Waning Pertussis Immunity: A Follow-up Analysis

Skoff TH, Martin SW
JAMA Pediatr. 2016;170:453-458

Study Summary

This study was a follow-up of a previous analysis of outcomes of children who received only the acellular and not the whole-cell pertussis vaccine, both initially and during tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccination in adolescence, adding data up through 2014. Cases of pertussis were identified by a US national surveillance system from 1990 through 2014. The children were stratified by age: less than 1 year, 1-10 years, 11-18 years, and 19 years and older. Important time points in the analysis were 2004-2005, when Tdap was introduced, and 2010, when all children would have received only the acellular pertussis vaccine through their early childhood immunizations.

More than 350,000 cases of pertussis were reported from 1990 through 2014. In the pre-Tdap era, the incidence of pertussis was already gradually increasing from 1.7 to 4.0 cases per 100,000 population. Throughout this period, infants were the age stratum most burdened by pertussis; but even in that group, the incidence markedly increased from 26.4 cases in 1991 to 127.2 cases in 2012 (per 100,000 population). The other age groups showed little change in incidence over the time period studied except for the 1- to 10-year age group, who experienced a marked increase in pertussis between 2007 and 2011. That same cohort demonstrated a significant rise in pertussis incidence when they reached age 11-18 years.

With the introduction of Tdap in 2005, pertussis cases declined at a very rapid pace among adolescents compared with all other age groups. However, in 2010, a marked increase in the incidence of pertussis occurred among 11- to 18-year-olds when those who had received only acellular vaccine throughout childhood entered adolescence. The investigators concluded that Tdap is still a very helpful vaccine for reducing pertussis in adolescence. However, the vaccine appears to be less effective overall in the cohort of adolescents who were initially immunized only with the acellular pertussis vaccine.

Viewpoint

Growing data suggest that immunity to pertussis among patients who received only acellular pertussis vaccines wanes very quickly. Waning immunity appears to be an issue for both the primary series as well as the protection conveyed by Tdap boosters. I recently reviewed a very similar study[1] that demonstrated that adolescents in the Kaiser-Permanente system who had received only acellular pertussis vaccine during the primary series had declining effectiveness of protection against pertussis after receiving Tdap. Studies have demonstrated that children who received at least one whole-cell pertussis vaccination (eg, those who were vaccinated during the period of transition between whole-cell and acellular vaccines) had better childhood protection as well as a more sustained booster effect in adolescence when they received Tdap.

Of interest, Skoff and Martin demonstrated epidemiologic peaks in pertussis incidence in 2004-2005 and 2011-2012 in virtually all age groups, including infants (age up to 12 months). This suggests that the reduced protection in adolescence explains, at least in part, the same epidemiologic spike in pertussis incidence that was noted in infants. In fact, this is such a hot topic lately that another study in the same issue of JAMA Pediatrics[2] estimated the potential benefit of a single dose of whole-cell pertussis vaccine in infancy as a way to “prime” patients for later receipt of acellular vaccine. Such a strategy would be very effective, reducing infection in neonates by 96% and perhaps saving more than $142 million in the United States annually. In any case, stay tuned because this appears to be a hot area of investigation with additional data coming every year.
Source: JAMA Pediatr. 2016;170:453-458.

http://www.medscape.com/viewarticle/864184

Whooping Cough Vaccine Doesn’t Work so They’re Trying to Make a New One

A disease doctors thought had long gone has come back to cause illness and even death. But an international team of scientists has been formed to help build new treatments against it.

The tragedy is that the disease, whooping cough, which can affect people of any age is particularly dangerous for infants and young children.

We have vaccines for the condition but they have gradually become less effective so their ability to protect is failing.

This has prompted the formation of a group of leading scientists from 22 institutions who will lead the way to more effective whooping cough vaccines.

Called Periscope the pan-European project has a budget of €28 million from the EU, the Bill and Melinda Gates Foundation and from industry.

Old vaccines

Scientists from Trinity College Dublin led by Prof Kingston Millshave been drafted into this team and will play a central role in the research that follows.

“We thought until a few years ago we didn’t have to worry about whooping cough,” said Prof Mills, who is Trinity’s professor of experimental immunology.

A vaccine was developed in the 1980s and came into widespread use but it had side-effects, he said.

A better one came on stream in the 1990s and is the one we use today but it had hidden problems, Prof Mills said.

His lab showed that the current vaccine didn’t deliver long-lasting protection against whooping cough, also called pertussis.

Epidemic outbreaks

This has led to an increasing number of cases worldwide and epidemic outbreaks, Prof Mills said.

One in the UK in 2012 caused 13 deaths and in that year the US saw more cases of the disease than were seen before any vaccines came along.

A recent Australian outbreak triggered 15,000 cases and other countries are experiencing similar problems

“We really need a new vaccine,” Prof Mills said. It is hoped that this international effort will do just that.

Source: The Irish Times, 8th August 2016.

http://www.irishtimes.com/news/science/whooping-cough-s-return-prompts-search-for-new-vaccine-1.2748484

29 Cases of Whooping Cough, ‘Most’ Vaccinated

An outbreak of 29 cases of whooping cough in the local community in recent weeks worries local health community and school officials.

Pertussis patients had been vaccinated

Even more unusual, both locally and in last spring’s outbreak in Abington, is the fact that most of the cases were high school students who had been vaccinated and had received all their required boosters,including the Tdap booster containing the tetanus, diphtheria and pertussis vaccine. That booster is normally given in middle school at 11 years of age.

Source: Public Opinion, Undated Article (2016).

http://www.publicopiniononline.com/story/news/2016/11/10/whooping-cough-outbreak-causes-concern/93547202/

Whooping cough cases double, weak vaccine partially to blame

So far this year, 379 cases of whooping cough have been diagnosed in Finland, more than double the amount (165) recorded in 2015.

Pertussis, better known as whooping cough, is a bacterial infection with symptoms including shortening of breath and severe coughing fits. At first the symptoms resemble a common cold, but as the disease progresses, it develops into a high-pitched wheezing cough, especially at night, that can last for 10 or more weeks.

Whooping cough is an airborne disease which spreads easily through the coughs and sneezes of an infected person. It can be life-threatening for small children, but people of all ages can fall ill.

Hanna Nohynek, chief physician and team leader of the vaccine programme development at National Institute for Health and Welfare (THL) says pertussis often appears in waves.

For example, in 2003 and 2004 Finland experienced a spike in whooping cough cases. After children under 6 received a booster shot to protect them, the number of cases dropped. In 2012, a round of whooping cough vaccine was cleared for conscripts.

The reasons numbers are again rising are many, but one may be the effectiveness of the vaccine used in Finland, which is gauged to be about 80 percent effective. Finnish children are vaccinated against the disease as babies at 3 and 5 months, and again at the ages of 1, 4 and 15 years.

“When vaccine effectiveness and the protection duration are less than 100 percent, some people who have been vaccinated are bound to spread the disease,” the THL physician says.

Source: Yle UUTISET, 3rd December 2016.

http://yle.fi/uutiset/osasto/news/whooping_cough_cases_double_weak_vaccine_partially_to_blame/9332275

3 San Juan Island children have whooping cough – The Report Says ‘Even fully vaccinated people can become infected with or spread pertussis.’

Three children on San Juan Island have been diagnosed with Pertussis, or “whooping cough.” Pertussis is a highly contagious bacterial infection, and is one of the most common vaccine-preventable diseases in the United States.

San Juan County Health & Community Services is currently working with the families of these children to investigate the pertussis cases. None of the children have been hospitalized.  It usually starts with mild cold symptoms or a cough, which turns into severe coughing spells. Infants and children can cough violently and rapidly, which can cause them to inhale with a loud “whooping” sound.

If untreated, an infected person can spread pertussis for several weeks. Because pertussis is highly contagious, pertussis outbreaks can occur even in vaccinated populations, though the symptoms tend to be less severe. Even fully vaccinated people can become infected with or spread pertussis.

Source: San Juan Islander, 2nd December 2016.

http://sanjuanislander.com/news-articles/23605/3-san-juan-island-children-have-whooping-cough

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