Health Editor’s Note: Pertussis, more commonly known as whooping cough or the 100-day cough, is a bacterial disease which is highly contagious since it is spread by coughing and runny noses. This video is a window into a preventable disease. How horrible for this baby to try to breathe! This is what the disease looks like.
The whole-cell vaccine for pertussis was developed in the 30s and with the use of vaccines all over the world, the cases of pertussis had decreased by 157-fold by 1970. Pertussis appears first to be a common cold, but when the fits of coughing become severe, with vomiting, broken ribs, becoming exhausted from coughing that lasts several weeks, it is highly apparent that one is dealing with a disease that can cause great harm. Coughing can usually last for 10 weeks.
Infection can occur without symptoms, thus the ability to spread the disease by those who are carriers. Sometimes, in babies under one, there will be little or no coughing but the baby will have episodes of not breathing at all. Scary for baby and those around him or her! Pertussis has two sources, pertussis and B. pertussisillness with pertussis causing only a very small number of cases and B. pertussis causing illness in all age groups. Most cases of pertussis occur in the developing world, to the tune of an estimated 16.3 infected in 2015 alone. 0.5% of babies, under one year of age, die if they when infected with pertussis.
Pertussis vaccines have gone through countless changes over the decades in order to obtain a vaccine that addresses the disease, i.e. stops it, and is safe. It has been found that older vaccines for pertussis may become less effective over the years and a booster is needed. Even having the actual disease does not guarantee a life-time immunity.
The best attack on this disease is prevention with recommendation of giving vaccines for pertussis to pregnant women so the infant will have passive immunity the mother will pass on and by giving the first dose of at six weeks instead of eight weeks. The key is immunity whether by natural immunity or vaccines. Testing for pertussis (swab of the nose and throat) is highly accurate and more cases are being caught before the bacteria can infect others. Also, it has been proven that natural immunity (from having the disease) wears off more quickly than immunity obtained by vaccines. There have been some mutations in the pertussis bacteria, but not enough to make vaccines inadequate, at least for several years, until immunity wears thin. Bottom line, vaccines will help to prevent pertussis, but need to be renewed. Not something that will please anti-vaxxers, but then again neither should this video……Carol
Flawed Vaccine Not to Blame for Whooping Cough Resurgence
Increase in cases signals end of vaccine ‘honeymoon period,’ study suggests
by Salynn Boyles, Contributing Writer
The surprising resurgence of whooping cough in the United States in recent years cannot be blamed on shortcomings in the current vaccine, a new study finds.
Rather, incomplete coverage among children — possibly fueled by the anti-vaccination movement — is responsible for the pertussis increases, along with natural population turnover and slowly waning protection from the vaccine, researchers say.
In the study published online in Science Translational Medicine, the team found little evidence that the switch in the 1990s from the whole cell to the combined acellular pertussis vaccine contributed to the resurgence in whooping cough.
During the 1970s and 1980s, an average of 2,000 to 3,000 pertussis cases were reported annually, according to figures from the U.S. Centers for Disease Control and Prevention (CDC).
In 2003, pertussis cases in the U.S. increased to more than 10,000 for the first time in almost 4 decades, and have not dropped below this number since. In 2012, there were 48,277 reported cases, followed by 28,639, 32,971, 20,772, and 17,972 cases in 2013, 2014, 2015, and 2016, respectively.
The CDC recommends a series of five pertussis shots to be given before age 7, combined with the diphtheria and tetanus vaccines (DTaP), with a booster dose (Tdap) recommended around the age of 11.
“The conventional wisdom has been that the current vaccine may not protect for very long, but we found strong evidence that this is not the case,” study co-author Aaron King, PhD, of the University of Michigan in Ann Arbor, told MedPage Today.
“A small fraction of people who get the vaccine appear to be capable of being infected again after a relatively short period of time. But this is such a small number that the overall efficacy of the vaccine is quite high.”
The researchers employed disease-transition models and statistical analysis to examine three potential modes of failure: primary vaccine failure; failure in the duration in the waning of vaccine-induced protection with time and failure in the degree of protection, also known as vaccine “leakiness.”
“We formulated transmission models comprising competing hypotheses regarding vaccine failure and challenged them to explain 16 years of highly resolved incidence data from Massachusetts,” the researchers wrote. “Our results suggest that the resurgence of pertussis is a predictable consequence of incomplete historical coverage with an imperfect vaccine that confers slowly waning immunity.”
Specifically, the team examined age-stratified pertussis incidence data from Massachusetts from 1990 through 2005, which was before the introduction of the Tdap booster, employing statistical methods for extracting information from the data that could be generalized to the entire U.S. and to western Europe.
King explained that the introduction of the first pertussis vaccine in the late 1940s led to what the researchers refer to as a honeymoon period where very low disease incidence was seen.
The analysis suggested that the resurgence of pertussis in recent decades signals the end of this honeymoon period.
Pertussis was a common, and deadly, childhood disease before the 1950s. But the combination of the introduction of the vaccine and natural immunity among a large percentage of adults who had the disease as children led to dramatic declines in incidence.
King said the cyclical increase in pertussis cases in recent decades does not support the idea that the vaccine is ineffective or that changes in the vaccine have contributed to the resurgence: “The roots of the resurgence go back 2 decades before the switch from the whole cell vaccine was made. What we are seeing is in part due to the fact that we are not vaccinating enough people and in part due to the decline in adults with naturally acquired immunity.”
He said that even though protection from the pertussis vaccine gradually wanes over time, it lasts far longer than many in the field have suggested.
“For 90% of people who get the vaccine, immunity is lasting longer than 10 years, and for over half it is lasting an entire lifetime.”
The finding that schoolchildren now represent a core transmission group has implications for public health efforts to address the pertussis resurgence, the researchers noted. “Efforts aimed at curtailing transmission in the population at large, and especially in vulnerable infants, are more likely to succeed if targeted at schoolchildren, rather than adults.”
King and co-authors reported having no relevant conflicts of interest related to this study.
Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Primary Source: Science Translational Medicine
Source Reference: Domenech M, et al. “The impact of past vaccination coverage and immunity on pertussis resurgence” Sci Transl Med 2018; 10 (434): eaaj1748.