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Some research on Pertussis outbreaks

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#1 EBeditor

Posted 28 April 2012 - 06:28 PM

Vaccination has been a hot topic here over the last couple of weeks, with the effectiveness of the pertussis vaccine under particular scrutiny. So I thought some of you may be interested in an article about some new research which has been done. Some extracts below:

Ever since the 2010 California pertussis outbreak, in which there were 9,154 cases of pertussis, the most in 63 years, and 10 infants died, many people, especially parents, are wondering why we are seeing more pertussis these days.

Is it because the pertussis vaccines simply don't work, as the anti-vaccine movement would have you think?

Or is it because there are higher rates of unvaccinated kids these days and parents using alternative immunization schedules, instead of the standard immunization schedule from the CDC?

A new commentary that will appear in the May issue of Pediatrics, "Why Do Pertussis Vaccines Fail?," may finally give us some answers.

While the title of the article might have you think that all of the blame lies with the pertussis vaccines, that certainly isn't the case. While there can be vaccine failures with the pertussis vaccines, just like any other vaccine, that doesn't mean that the vaccine doesn't work for most children.

One of the problems is that the DTaP vaccine likely doesn't work as well as the older DTP vaccine and likely doesn't work as well as we used to think it did. So instead of efficacy of 84 to 85%, as was once believed, it is likely closer to just 71 to 78%.

the high rates seen in 2010 in California are still well below the rates that were seen in the prevaccination era, when the attack rate of pertussis in the United States was as high as 157 per 100,000 people, with about 200,000 cases a year.
[There were 2010 9000 cases in 2010.]
What's the answer? It certainly isn't for more kids to follow alternative immunization schedules or to simply skip vaccines all together. Natural immunity isn't going to keep newborns and infants from getting pertussis, the ages which are most at risk for life-threatening infections, as they catch pertussis from people around them, including those working on their natural immunity. Natural infections don't even provide life-long protection against pertussis, as some people believe. That natural immunity wanes fairly quickly too.

In a 2009 study that appeared in Pediatrics, researchers found that "vaccine refusers had a 23-fold increased risk for pertussis when compared with vaccine acceptors, and 11% of pertussis cases in the entire study population were attributed to vaccine refusal." And since pertussis is highly contagious, with every primary case typically infecting as many as 17 other people, it makes sense that higher rates of children using vaccine exemptions could be at least one of the factors in these outbreaks.

In fact, one article, "Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis," found that "geographic pockets of vaccine refusal are associated with the risk of pertussis outbreaks in the whole community."


#2 Indatree

Posted 28 April 2012 - 06:35 PM

Thanks for posting this, due with second child in July and thinking a lot about this topic. Thankfully family are happy to get vaccinated too to keep bubs safe.

#3 new~mum~reenie

Posted 28 April 2012 - 06:50 PM

Please PLEASE be aware that the cause of Australia's whooping cough epidemic since 2008 is a NEW STRAIN of pertussis that is vaccine resistant!!!

People who are vaccinated are getting it and sharing it around under the assumption that they are vaccinated, therefore 'safe' and 'cant have whooping cough' therefore continue going to school/work/shops etc

"The prolonged whooping cough epidemic in Australia that began during 2008 has been predominantly caused by the new genotype of B. pertussis," said one of the study authors, Associate Professor Ruiting Lan, of the UNSW School of Biotechnology and Biomolecular Sciences.
"The genotype was responsible for 31 percent of cases in the 10 years before the epidemic, and that's now jumped to 84 percent -- a nearly three-fold increase, indicating it has gained a selective advantage under the current vaccination regime.
"The vaccine is still the best way to reduce transmission of the disease and reduce cases, but it appears to be less effective against the new strain and immunity wanes more rapidly. We need to look at changes to the vaccine itself or increase the number of boosters," Associate Professor Lan said.


#4 new~mum~reenie

Posted 28 April 2012 - 06:54 PM

WHEN my nine-year-old son woke up last month with a low fever and a scratchy throat, I didn't think beyond how to manage work with him at home.
The symptoms gave way to a barking cough a few days later, so I rang my GP's office. My son had been exposed to whooping cough at school, I told the nurse, but it can't be that because he's fully vaccinated. I just wanted to check what to do. "Bring him in and tell the girls at the desk," she said. "They'll put him in isolation until the doctor sees him." Thinking she hadn't heard, I said: "But he's vaccinated." "I know," she said. "But he might have whooping cough all the same."

As I was to learn, Australia is in the grip of the largest and longest-running epidemic of whooping cough since mass vaccination started more than half a century ago. The numbers have been increasing dramatically - 38,606 cases reported last year, compared with only 4863 in 2007 - and eight babies have died since 2008. This is despite Australia boasting one of the highest vaccination rates in the world. But, as it turns out, even some of those who've been vaccinated are falling sick


#5 Imaginary friend

Posted 28 April 2012 - 07:08 PM

Th whooping cough vaccine is not perfect - it does not last longer than about 10 years and it does not always entirely cover one against getting whooping cough - but people who do get it usually get much milder cases than unvaccinated people.

Also  I would dispute that whooping cough rates are ever increasing - whooping cough is well known for being cyclical - so some years are worse than others for no of cases - but   the overall trend over a larger number of years is not ever increasing.

It must also be said the the number of cases reported does not neccesarily mean there are more cases - have to factor in whether more people are getting tested etc - highly likely there were many undiagnosed cases in previous years, especially in adults.

#6 Soontobegran

Posted 28 April 2012 - 07:30 PM

NMR---please note that all not all people with Pertussis have the strain for which vaccines are less effective.
I am sorry if I don't understand the point of your post? Are you saying that people shouldn't bother?

#7 Soontobegran

Posted 28 April 2012 - 07:30 PM


Edited by soontobegran, 28 April 2012 - 07:50 PM.

#8 new~mum~reenie

Posted 28 April 2012 - 07:35 PM

Fair enough, although many are saying it is 'resistant'.
Here is the original findings from a professor in NSW

It is still important for people to be aware of this strain though, as they are less likely to seek medical attention and assume it isn't whooping cough.

Australia’s prolonged whooping cough epidemic has entered a disturbing new phase, with a study showing a new strain or genotype capable of evading the vaccine may be responsible for the sharp rise in the number of cases.

A team of Australian scientists, led by the University of New South Wales (UNSW),  believe this emerging new genotype (called prn2-ptxP3) of the Bordetella pertussis bacterium may be evading the protective effects of the current acellular vaccine (ACV), and increasing the incidence of the potentially fatal respiratory illness, according to the study published in The Journal of Infectious Diseases.


#9 new~mum~reenie

Posted 28 April 2012 - 07:45 PM

STBG - as outlined in the article in my second of my posts, people are assuming they are ok because they are immunized - and not seeking medical treatment. They are the people that are more likely to be shopping etc and exposing those even more susceptible (elderly, people with newborns etc)

No way am I saying dont bother immunizing.

But as a mum who is 30 weeks pregnant working at a checkout, I am keenly aware that I am at a higher risk of catching this other strain. That my soon to be newborn is more susceptible to catching this strain etc. I will be far more protective in the first 6 months this time compared to when DS was born.

Knowledge is power.

Edited by new~mum~reenie, 28 April 2012 - 07:46 PM.

#10 IamzFeralz

Posted 29 April 2012 - 07:37 AM

QUOTE (Poet in New York @ 28/04/2012, 07:13 PM) <{POST_SNAPBACK}>
We also need to remember that in Australia the whooping cough vaccine changed in 1987 from whole cell vaccines to acellular, to curb the side-effects. I do wonder whether Australia will eventually need to revert back?

Eventually they will be able to modify the vaccine to include the new strain I would think in a similar way that the flu vaccine is modified each year to include new strains of the flu.  However, pertussis has always been a tricky one to nail down because of the fact that its so contagious and immunity wanes so quickly.  The immunity from natural type infection also wears off faster over time compared to other diseases, although it lasts longer than vaccine induced immunity.

Duration of immunity against pertussis after natural infection or vaccination.
Wendelboe AM, Van Rie A, Salmaso S, Englund JA.

Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA. awendelboe@unc.edu

Despite decades of high vaccination coverage, pertussis has remained endemic and reemerged as a public health problem in many countries in the past 2 decades. Waning of vaccine-induced immunity has been cited as one of the reasons for the observed epidemiologic trend. A review of the published data on duration of immunity reveals estimates that infection-acquired immunity against pertussis disease wanes after 4-20 years and protective immunity after vaccination wanes after 4-12 years. Further research into the rate of waning of vaccine-acquired immunity will help determine the optimal timing and frequency of booster immunizations and their role in pertussis control.

#11 mumtoactivetoddler

Posted 30 April 2012 - 07:08 PM

I can't give hard evidence but when the woman from the Department of Health NSW rang me last year as my DD was a mandatory report for WC. She stated that they are seeing far more kids who are vaccinated with it, and they are going to have to do more research as to why. (We have had large numbers of vaccinated kids with it at our school).

#12 CandiceH

Posted 04 May 2012 - 04:30 PM

The reason the Department of Health would be saying there are lots of vaccinated kids getting whooping cough is because there are more vaccinated kids than unvaccinated kids.

small example:
If you have 1,000 people and 920 are vaccinated and, of course, 80 people unvaccinated.
(similar to childhood vaccination rate for Australia, around 92%, depending on age group)

The vaccine is about 70% effective (sorry, off the top of my head here)

so, we have 40% of people who get whooping cough despite being vaccinated.

40% = 368 notification of whooping cough in our imaginary vaccinated group.

Lets say every unvaccinated person gets whooping cough

100% = 80 people

This example clearly demonstrates WHY there are more notifications for vaccinated than unvaccinated YET all of the unvaccinated people in this example got Whooping Cough.

Hope this helps


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