A Pertussis Comeback? Blame it On Persistence.
Sep 28, 2010

By Christine Vara
If you live in California, than you’ve most likely heard of the pertussis epidemic that has been declared there.  However, here on the East Coast, many people are still not aware of the fact that pertussis (also known as whooping cough) is making a big comeback, which is putting the lives of infants, too young to be vaccinated, at great risk.
An article printed today, as a special segment in the Washington Post, provides an excellent explanation regarding the persistent nature of pertussis, and the challenges with the very vaccines that are intended to protect us from this disease.   
It’s no secret that there are pockets of the population who are increasingly inclined to decline vaccines (such as in certain areas of California).  While it can be easy to use those statistics to explain the comeback of many diseases, the recent pertussis epidemic is extremely complex and can’t be solely attributed to vaccine refusal.   As the author of this special segment explains, there are many contributing factors at work here, and many have to do with the persistence of this particular disease.
First, we must recognize that pertussis is extremely infectious – much more than smallpox, polio or influenza.  Yet, it is often difficult to diagnose, since most adult cases develop from symptoms that often mimic a terrible, nagging cough and cold.  While in some cases, adults may go totally undiagnosed, in other cases, even a test might produce a false negative that further delays proper identification and treatment of the disease.
But wait.  Didn’t we get vaccinated as kids and shouldn’t that shot protect us?
Well, most likely the answer here is yes….and yes.
But here is the challenge.  Immunizations have limitations.
Take the point the author makes of vaccine development.  When a pertussis vaccine was first introduced it was a whole-cell vaccine that was extremely effective.  Prior to the vaccine, whooping cough claimed 10,000 lives each year in the US alone.  As the author explains, this number dropped by more than 99% after the introduction of the vaccine.  Now that is amazingly effective.
However, due to instances of seizures and high fevers, the whole-cell vaccines were eventually replaced by acellular vaccines.  So while it was important for science to develop a vaccine that reduced the risk of side effects, they had to accept that the new vaccine may have some limitations.  While the new vaccines still managed to be 80-90% effective, sometimes immunized people were still getting lighter versions of the disease and were still contagious.
To complicate matters further, pertussis is just very persistent.  Since 1976, the pertussis infection numbers have begun creeping up and the concern here is that the pertussis bacteria has evolved to evade vaccine-produced immunity.  Unfortunately, the truth is that vaccination doesn’t always prevent you from getting pertussis.  However – and I want to emphasize this important fact – neither does natural infection.  In other words, even if you’ve had pertussis, you can still get it again.  Now that’s what I consider a persistent disease.
So how do we protect ourselves from pertussis? Well, since the immunity you receive from the vaccine continues to wane over time, the best defense is to get a pertussis booster every 10 years.
You may be asking, “Why should I get the vaccine if I may still end up getting pertussis?”  The simple answer is that the vaccine offers more immunity to those that have had the shot, than to those who haven’t.  Additionally, by protecting yourself, you are helping to eliminate the spread of the disease to others, such as infant children, who often die as a result of the disease and are too young to be fully vaccinated.
While we may never be able to guarantee the 100% effectiveness of a vaccine, consider the advice from a friend of mine who suffered with an adult case of pertussis several years ago, “I’ll give you a guarantee.  If you get pertussis, I guarantee you will have wished you had done anything and everything to avoid it.”
Pertussis may be persistent, but we have got to continue to put up a fight.    If you haven’t done so already, get the adult pertussis booster and make sure all children over the age of 10 continue to get their booster shots as well.

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