For my previous post on this topic go here.
My daughter has been very ill since last weekend so we took her to the doctor on Monday, and told them of the information from her school that a case of whooping cough had been diagnosed earlier in June. I received the call yesterday afternoon from the nurse at my daughter's pediatrician's office: the test she had on Monday administered by her doctor showed she had pertussis (a/k/a whooping cough) and not some rhinovirus or the common cold.
My daughter had her last pertussis booster shot in 2006, so we thought we were in the clear, but obviously the new vaccine developed in 1997 (which doesn't use the whole cell of the pertussis bacterium to make) is less effective than the prior vaccine and the immunity it provides wanes more quickly. So now everyone in our family is on antibiotics since we have all been exposed to the pertussis bacteria as a result of our constant contact with her.
Do yourself a favor. There is a pertussis epidemic spreading throughout the US this year. It hit Washington State first and hardest, but it has spread to many other states, including the Mountain West, the Midwest, the Mid-Atlantic and the Southeast. If you have cold symptoms, please check to see if there has been any reported pertussis cases in your state and community.
Even if you have had your TDaP (Tetanus, Diptheria and acelluar Pertussis) vaccine booster within the past ten years, you may still get this illness. It can be life-threatening to infants, the elderly, people with diabetes and people with compromised immune systems. Plus, if undiagnosed within the first 2-3 weeks, the antibiotics used to fight a pertussis infection will be ineffective. This is because the severe cough (which can last for months) only comes after the pertussis bacteria has died and released toxins into your lungs.
The weeks to months-long cough is a by-product of the toxins and adults have had such severe coughing spells that they succumb to exhaustion, and on occasion even break ribs. The outbreak is spreading quickly this year, in part due to the less effective acelluar pertussis vaccine (which is synthesized from only some of the protein antigens of the pertussis bacteria), and in part because many people, especially adults are not up to date with their vaccinations. Don't risk losing your summer to this illness, and don't place the more vulnerable members of our society at risk, for though you may catch a mild case, you can spread the disease to others who may then pass it on to someone -- a child, or other person at risk -- for whom this illness could have life altering effects.
If your last booster shot was more than five years ago, get another one. And if you get cold like symptoms (congestion, sore throat or cough) check with your doctor to see if a test for pertussis is recommended. If my daughter's high school had not informed us that there had been a case diagnosed at her school we would have never known to check for this disease. We would never have considered that we might be at risk of contracting a disease for which we were vaccinated as children. Yet my daughter did, and I also came down with cold-like symptoms from being around her. And I had my booster shot a week before she became sick.
She was deathly ill - unable to sleep, coughing, sore throat -- and not a happy camper. My symptoms were not as severe as hers (no cough thankfully) , so perhaps the booster shot I had the week before she became ill provided some immunity, but I feel much safer now knowing that my family is receiving the proper treatment so our exposure to this bacterial illness will not result in a more severe condition. I also feel good that we will soon no longer be potential carriers of this disease.
One person in the comments questioned why get vaccinated if the vaccine is "ineffective." It is true that some studies indicate that the immunity conferred by the acelluar pertussis vaccine is not as long lasting as the previous whole cell vaccine administered before 1997. However, this does not mean it is ineffective, only that adults may need to receive booster shots more frequently:
Despite widespread childhood vaccination against Bordetella pertussis, disease remains prevalent. It has been suggested that acellular vaccine may be less effective than previously believed. During a large outbreak, we examined the incidence of pertussis and effectiveness of vaccination in a well-vaccinated, well-defined community. Methods. Our center provides care to 135 000 patients, 40% of the population of Marin County, California. A total of 171 patients tested positive for B. pertussis from 1 March to 31 October 2010 by polymerase chain reaction (PCR). Electronic medical records were reviewed for demographic characteristics and vaccination status. Results. We identified 171 cases of clinical pertussis, 132 of which were in pediatric patients. There was a notable increase in cases among patients aged 8-12 years. The rate of testing peaked among infants but remained relatively constant across ages until 12 years. The rate of positive tests was low for ages 0-6 years and increased among preadolescents, peaking among those aged 12 years. The vaccination rate among PCR-positive preadolescents were approximately equal to that of controls. The vaccine effectiveness was 41%, 24%, and 79% for children aged 2-7 years, 8-12 years, 13-18 years, respectively. Conclusions. Our data suggests that the current schedule of acellular pertussis vaccine doses is insufficient to prevent outbreaks of pertussis. We noted a markedly increased rate of disease from ages 8-12 years, proportionate to the interval since the last scheduled vaccine. Stable rates of testing ruled out selection bias. The possibility of earlier or more numerous booster doses of acellular pertussis vaccine either as part of routine immunization or for outbreak control should be entertained.Another link regarding the issue of long term immunity regarding the acelluar pertussis vaccine:
"Continued evaluation of DTaP duration of protection is needed to determine the appropriateness of timing of pertussis vaccinations," said Dr. Tartof, an epidemic intelligence officer in the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases in Atlanta.It should be noted that children did not lose all immunity to pertussis, but that the rate of those still considered immune decreased over 6 years from near 100% to between 60-70%. Plus, the main concern is that many adults have no immunity at all since their last booster shot may have been decades ago. Even whole cell pertussis vaccine does not give one life long immunity. Thus, the problem isn't that the vaccine doesn't work, the problem is that people need to be re-vaccinated more often, or we need to return to the whole cell vaccine for longer immunity. Avoiding vaccination is not the solution:
Dr. Tartof and a second CDC researcher presented results from two independent studies that both showed children faced a substantially increased rate of pertussis infection 4 or more years out from their fifth and final childhood vaccination, which these days usually occurs when U.S. children are 4 years old. Recent surges in U.S. pertussis cases, which began in 2005, and then spiked even higher in 2010, implicated the acellular vaccine as the cause.
"It certainly caused the 2010 California epidemic, and it happened in Minnesota and Oregon, too. Waning immunity with acellular pertussis led to greater vulnerability in 7- to 10-year-olds," commented Dr. Kathryn M. Edwards, Sarah H. Sell professor of pediatrics and director of the Vaccine Research Program at Vanderbilt University in Nashville, Tenn.
"The durability of protection with the acellular vaccine is not as good as with the whole cell vaccine, but the problem with the whole-cell vaccine was that it was quite reactive," causing local reactions and fevers, she said in an interview.
"At this point, people would not accept the whole-cell vaccine," which means something needs to be done with the acellular vaccine, she said. Possible options include additional boosted vaccinations, or moving administration of the fifth childhood dose of DTaP from 4-year-olds to 6-year-olds. [...]
The second CDC study, presented by Dr. Tartof, used data collected by the immunization registries of Minnesota and Oregon for children immunized against pertussis during 1998-2003, and data on pertussis cases in these two states from reports to the CDC through the National Notifiable Disease Surveillance System. This analysis included 224,378 fully immunized children and 521 pertussis cases in Minnesota, and 179,011 fully immunized children and 99 reported cases in Oregon.
Dr. Tartof and her associates used these data to calculate a pertussis incidence rate during each year following delivery of the fifth childhood dose, and reported the relative risk for infection during each follow-up year relative to the first 12 months after the fifth dose. By the sixth year, the risk was seven-fold higher in Minnesota, and four-fold higher in Oregon, she reported. The risk for infection rose steadily during each year following the fifth dose.
Cherry said there is evidence that immunity to pertussis from any source — whole-cell vaccines, acellular vaccines or even from surviving whooping cough — wanes over time, and that the disease is circulating among teens and adults who come down with the disease but are rarely diagnosed.
Longer-lasting vaccines against whooping cough are not likely to be developed anytime soon, so public health officials and others are trying to find other ways to stem the outbreaks, and in particular to protect newborns. Infants too young to be vaccinated are among the most likely to become severely ill, be hospitalized or even die from the disease. [...]
Public health officials are recommending that new parents and anyone else caring for newborns receive a booster. Some hospitals are offering new moms a whooping cough vaccination in the hospital after delivery. At Dr. Anita Chandra-Puri's pediatric practice in Chicago, new fathers are offered a shot as well.
Chandra-Puri, who said she treated a baby who had to be hospitalized this fall because of the disease, said most parents were happy to get the vaccine as news spreads of the whooping cough cases in Illinois.
"It has been parents initiating the question," she said. "It seems like a no-brainer to get vaccinated."
It is a no-brainer. Get vaccinated. And if you have cold-like symptoms this summer, ask your doctor for a pertussis test.