Home > In the News, Preventable Diseases, Science & Research > Pertussis Vaccine: The Good, the Bad and the Ugly

Pertussis Vaccine: The Good, the Bad and the Ugly

iStock_000043678332_XXXLarge.jpgLast week, a new study published in Pediatrics suggested that the pertussis immunity from the recommended adolescent Tdap booster was quick to wane.  While this is being reported by many as “news”, public health experts, immunologists and epidemiologists have long been familiar with the torrid history of pertussis vaccines and the unfortunate reality that the current pertussis vaccine does not provide long term protection.

Ever since the acellular pertussis vaccine was introduced in the late 90’s (DTaP), several studies have suggested that the pertussis immunity didn’t last as long as the previous whole cell pertussis vaccine (DTP) that first became routinely recommended for children back in the 1940’s and 1950’s.

In fact, waning immunity among the adolescent population is precisely what prompted the Advisory Committee on Immunization Practices (ACIP) to recommend an adolescent Tdap booster at ages 11-12 back in 2006.  At the time, the immunity received from recommended series of DTaP shots administered at ages 2, 4, and 6 months, with boosters administered at ages 15-18 months and again at 4-6 years of age, was determined to be waning in teens, so an adolescent booster was added to the recommended schedule as well as a recommendation for adults to receive one Tdap booster as well.

So why is last week’s study creating such a fuss when the data is not much different than what has been seen in previous studies?  

Last week’s study determined that effectiveness during the first year after adolescent Tdap vaccination was 69% but then decreased to 9% by four or more years after vaccination.  The study concluded that Tdap vaccine provided moderate protection against pertussis during the first year and then waned rapidly so that little protection remained 2-3 years after vaccination. It also concluded, like many studies before, that adolescents who were more remote from Tdap were significantly more likely to test positive for pertussis than were those vaccinated more recently.

But even as far as 2005, we see similar trends in the published data.  One such review on duration of immunity revealed that infection-acquired immunity against pertussis disease wanes after 4-20 years and protective immunity after vaccination wanes after 4-12 years. In 2014, another study looked into the evidence of rapidly waning immunity and the difference in effectiveness by Tdap brand. The results showed that immunity waned to 75% after one year, 68% after two years, 35% after three years and 12% after the fourth year with a slightly higher estimate among one brand than the other.  Then in 2015, another study investigated Tdap effectiveness among adolescents who received only acellular pertussis vaccines and found 73% effectiveness one year after vaccination, 55% effectiveness one to two years after vaccination, and 34% two to four years after vaccination.

The latest data really doesn’t offer a lot of new information, except that the numbers are slightly worse than we’ve seen in the past.

In response to these repeated findings,  many are questioning whether the ACIP will  consider changes to the adolescent and adult Tdap booster recommendations? 

The short answer is probably not.  But to understand why, we must look at how we’ve come to be where we are today.

Pertussis vaccines first became available back in the 1920’s, but it wasn’t until the 1940’s and 1950’s that a pediatric whole cell pertussis vaccine (DTP) became routinely recommended for children.  It was considered a good thing at the time because in the mid-1930’s to 40’s, the United States was suffering with more than 200,000 pertussis cases and over 4,000 pertussis-related deaths each year. Fortunately, after the routine use of childhood whole cell pertussis vaccine, the number of reported pertussis cases declined dramatically. By 1970, the reported incidence had declined greater than 99% and we hit a historic low of just 1,010 cases in 1976.

But before long, the pertussis predicament got ugly again.

Deadly-Choices-JacketAs Dr. Paul Offit elaborates in his book Deadly Choices, and Seth Mnookin covers in detail in his book The Panic Virus, everything changed in the spring of 1982, when the local NBC affiliate in Washington, DC, aired a program entitled “Vaccine Roulette”.  It was then that reporter Lea Thompson kicked off a campaign of fear in her hour-long special. Pertussis cases were low at the time, and people no longer feared infection from a bacteria that made it near impossible to breath.  Instead, Thompson introduced new fears by featuring the personal narratives of parents who alleged that their children had suffered permanent injury as a result of the pertussis vaccine.  Thompson’s reporting not only struck to the core of a parent’s overwhelming instinct to protect their children, but it aggressively attacked the “medical establishment” for mandating the vaccine for public school children and willfully ignoring the horrible consequences of injury.

In the days after the special aired, one viewer, Barbara Loe Fisher, was so captivated by the concerns Thompson raised about the pertussis vaccine, that she was moved to take action. Two years prior, Fisher’s son had received his fourth DPT shot.  Fisher alleged that within hours of vaccination he suffered a convulsion to which she attributed brain inflammation that left her son suffering with multiple learning disabilities and attention deficit disorder.   Thompson’s “Vaccine Roulette” inspired Fisher to seek out other parents who suspected vaccine injury.  She subsequently co-founded the National Vaccine Information Center, and just like that the modern day “anti-vaccine” movement was born.

From there a whole lot of bad has happened, mixed in with some good.

While Fisher was poised to distinguish herself as a consumer advocate, who could have helped to institute vaccine safety reforms at a time when the public health system was evolving, she has since become a harsh critic of vaccines, advocating for alternative medicines over vaccines and promoting her belief that all vaccines are dangerous and ineffective.

Raising concerns about the safety of whole-cell pertussis vaccines prompted the development of a more purified (acellular) pertussis vaccine (DTaP) that was first licensed in the early 90’s.  By the year 1997, the ACIP recommended DTaP be used routinely in place of DTP for the full 5-dose pediatric schedule.  The good news was that it appeared less likely to provoke adverse events because these newer vaccines contain purified antigenic components of Bordetella pertussis.  The bad news is that the newer acellular pertussis vaccine is just not as effective in providing lasting immunity as the whole cell version.  This is exactly what we have been reminded of with last week’s study.

There is no doubt that we will continue to see cyclical peaks in pertussis, and it’s believed that these are not solely due to increased numbers of families exempting their children from vaccines.  The increase in pertussis can also be attributed to several other things such as decreased vaccine efficacy, waning immunity among adolescents and adults vaccinated during childhood, increased diagnosis and reporting of pertussis because of greater awareness among physicians about the disease, and enhanced surveillance and more complete reporting of the disease.

In an attempt to compensate for the vaccine’s waning immunity, the ACIP continues to assess the current data and alter recommendations as needed.

Even though there are several recommendations pertaining to pertussis vaccine, Every Child By Two (ECBT) continues to field questions from parents asking why the ACIP doesn’t simply recommend more frequent Tdap boosters.  Couldn’t we prevent more pertussis cases if everyone was recommended a booster once every 4-5 years?

Certainly that solution sounds logical.  However, ACIP recommendations come at a cost.  Based on the evidence of limited immunity offered from the vaccine, it appears that it is unlikely that the ACIP will recommend more frequent boosters.

In fact, in 2013 a special working group for the ACIP analyzed information to determine if it would be beneficial to add an extra dose of whooping cough vaccine to be admin
istered at either age 16 or 21. They concluded that an extra dose would only slightly reduce the number of whooping cough cases, but would come at a high cost. They estimated that adding a dose at age 16 would cost the U.S. $77 million more than the current vaccination program, or about $270,000 for each case of whooping cough that was prevented.  Whereas, an extra dose at age 21 was estimated to cost $23.5 million more and $139,000 per case prevented.  Since young adults infected with whooping cough don’t often become sick enough to require hospitalization, it was determined that the cost-benefit was not justified at that time.

VYF_Full-Infographic-1However, as morbidity and mortality reports began noting that infants had a substantially higher rates of pertussis and the largest burden of pertussis-related hospitalizations and deaths, the ACIP began addressing these concerns with new vaccine recommendations. Research determined that in 85% of infant cases of pertussis, when the source of infection could be identified, the infection was found to be passed on from a mother or other member of the immediate or extended family.

This information has since led to numerous ACIP pertussis vaccine recommendations. 

First, in 2008, the ACIP recommended pregnant women receive a Tdap booster in the postpartum period in hopes that they would be less likely to pass on infection.  The recommendation was later updated in 2011 to include pregnant women and anyone who anticipates having close contact with infants under 12 months of age.  Not only does this help prevent infection of the mother who may later pass pertussis on to her child, but it also helps provide protective maternal antibodies to the unborn baby.  They are then given some level of protection before they can begin getting their own pertussis vaccination at two months of age.

Then, in 2013, the ACIP began recommending that pregnant women receive a Tdap booster in the third trimester of each pregnancy.  This is important given the fact that the amount of antibodies in your body is highest about 2 weeks after getting the vaccine, but then starts to decrease over time.  Vaccination during every pregnancy ensures that each baby gets the greatest amount of protective antibodies possible.

Additionally, since 2006, it’s been recommended that every adult get a Tdap booster once in their lifetime, and yet it’s estimated that only 26% of adults have even had this recommended Tdap booster.

While the current ACIP recommendations are expected to help reduce the incidence of pertussis in infants, organizations such as Every Child By Two (ECBT) are helping to educate the public about the importance of Tdap vaccinations for pregnant women, adolescents and adults.  ECBT’s new Vaccinate Your Family program promotes the benefit of vaccines for all age groups.  A suite of new shareable materials, such as their Grandparent Toolkit, have been specifically designed to highlight the importance of protecting newborns by vaccinating those around them.

 

FB Image_12 23_4

So, while the future of pertussis vaccine recommendations remains in question, we will continue to monitor the discussion at upcoming ACIP meetings and use this forum to communicate any changes that are being discussed.  By subscribing to this blog, you’ll receive notification of our coverage of all the future ACIP meetings, to include one scheduled at the end of February, 2016.

For many, the biggest question of all is when will we see a new and more effective vaccine? While there certainly is a need, there doesn’t appear to be any promising alternatives on the horizon. 

For now, the best we can do is adhere to the recommendations in place and encourage others to do the same.  

  1. reissd
    February 13, 2016 at 11:47 am

    What a combination of sad facts. Thank you for working to educate people and save lives.

    Like

  2. David M
    February 23, 2016 at 3:58 pm

    Why are healthcare professionals ignoring the 2014 Proceedings of the National Academy of Sciences (PNAS) study by Dr. Jason M. Warfel, “Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model?”

    My local clinic, Austin Regional Clinic, still posts up signs about cocooning to protect babies specifically from Pertussis. Unfortunately, the acellular vaccine most likely only eliminates the harsher symptoms and does not prevent the culturing and transmission of whooping cough. Because whooping cough is transferred from close contact, sneezing, and things of this nature- it means that a parent or other person who may have avoided contact with a baby too young to get vaccinated may pass Pertussis to the infant unaware of their condition.

    This is very dangerous, and the World Health Organization (WHO) has even listed the inability of the acellular vaccine to prevent infection and transmission as a likely reason for the rise in Pertussis.

    Like

  3. Chris
    February 23, 2016 at 8:57 pm

    Because human children are not primates. And while the DTaP is not perfect, it is better to reduce the coughing which decreases spread of the infection.

    Please call us after you have created a better way to prevent pertussis in children and infants.

    Like

  4. David M
    February 23, 2016 at 10:04 pm

    Chris, read the study. Studies like the one by Dr. Warfel are how Science works, you’re running dangerously close to the anti-vaxxer train of thought you most likely despise by rejecting scientific findings by saying “human children are not primates.” The research was stringent and easily replicable, it is well respected by the global community of scientist. The problem today is the “fear” based marketing pretending that cocooning is real. Did you see the pertussis commercial where the big bad wolf is holding a baby, little red riding hood. It’s paid for by big pharma, it’s a lie and it’s deceptive. The best research that we have through scientific means suggests that pertussis transmission is not prevented by our current vaccination. Logic suggests that if you can not see that someone has a bad cough, then you would not know to avoid bringing your baby near them. It’s harmful to use propoganda to tell the public that something like cocooning is true for Pertussis, when all of the science that we currently have says that it does not help.

    I’m more concerned that vaccination has become a holy religion. People have drawn themselves across lines that say you either vaccinate and 100% support it or you don’t. So much, that you would ignore the science yourself because you are entrenched in a belief that acellular pertussis vaccination is preventing the spread of pertussis despite science to the contrary.

    Do people with compromised immune systems have the right to see and avoid? Or, should they lock themselves up for the supposed greater good that is not medically or scientifically supported or proven for acellular pertussis vaccination. We have the years of data now to evaluate since some countries changed to acellular pertussis. Unfortunately, the majority appear to be ignoring it because it’s blasphemous to question any vaccination no matter how much evidence there is to the contrary…

    If you are coming from a place of caring about protecting children and infants then you will look into this subject yourself. If you don’t feel like looking at the science and evaluating the facts, then you don’t have any ground to push back at me with. If you don’t research it yourself, you are just blindly following someone else’s statements that you have no real knowledge of yourself and then you are effectively being a parrot.

    Please show me evidence that says cocooning is effective for acellular pertussis. Or scientifically discredit my first piece of evidence to the contrary.:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318410/

    Like

  5. Chris
    February 24, 2016 at 12:01 pm

    I dis, along with all of the commentary. It still boils down that humans are not non-human primates, and the lack of coughing does reduce the possibility of transmission.

    Now, where is your better solution to protect infants and young children from pertussis?

    Like

  6. Chris
    February 24, 2016 at 12:04 pm

    Sorry for the mistype: I did read it.

    Let me clarify: mice lie and monkeys exaggerate. Come back when you have a verified better way to prevent pertussis in infants and young children, that is not a warped version of the Nirvana Fallacy.

    Like

  7. David Mills
    February 24, 2016 at 12:19 pm

    If you read what I posted, you would see that he used baboons 96% genetically similar to humans, not monkeys. Then, if you read the actual study that I posted initially you will see the evidence that the current vaccine does not prevent colonization and transmission. BTW, it does not. There have been more studies since and geographic modeling of pertussis outbreaks confirmed it’s not the non-vaccinated that are driving the outbreaks. It’s just an American fallacy that’s been poured down the throats of an naive public. The rest of the world is admitting their mistake and moving forward and there are new vaccines on the horizon. Unfortunately, this vaccine is doing harm and it will continue to because of blind followers such as yourself who say Science is great, until it disagrees with my holy vaccination.

    Something interesting about the person who did this research for the FDA… he got bought out by Big Pharma, his latest research is a few sentences long confirming that mothers getting vaccinated while pregnant in their third trimester do effectively protect babies in nonhuman primate models. But, that’s in a nonhuman primate model, so it probably doesn’t interest you.

    Pertussis cocooning is still a dangerous lie that puts at risk populations such as the frail, elderly, pregnant women in the first two trimesters, etc… But, protect your holy vaccination idealism, despite absolutely 0 evidence that cocooning works for Pertussis. Show me one significant study…

    Like

  8. David Mills
    February 24, 2016 at 12:29 pm

    FYI, by bought out by big pharma, I mean that he literally works for Bristol-Myers Squibb as a Method Technical Transfer Lead. He literally left the FDA to go make some money with Big Pharma.

    Like

  9. Chris
    February 24, 2016 at 7:04 pm

    Again, please post your documented and verified method to protect infants and children from pertussis.

    Like

  10. David Mills
    February 25, 2016 at 4:28 am

    I respect that you want to help people. I’m agitated that you’re anything but fair or impartial with regard to your evaluation of the topic and that you surmise your conclusions. I’m confident that the current unscientifically documented and verified pertussis cocooning propaganda being pushed has “struck to the core of a parent’s overwhelming instinct to protect their children” and that this has become the new “fear campaign.”

    Regarding the continually regurgitated 85% statistics: The 85% statistic is misleading, clearly written from an angle and based on probables (not facts). Defining how many were probable vs how many were confirmed would’ve showed transparency. The anything but transparent estimate of 85% of SOI’s is intentionally misleading to promote this fear campaign. It just sounds better for the campaign than 37% of probable or confirmed cases of pertussis were able to be identified through interviews as coming from an immediate family member or extended family. Or an alternative, interviews concluded that 63% of those probable or confirmed pertussis cases did not come from family members or extended family. 37% is still a significant number, even if it’s not confirmed cases. Unfortunately, when some people are bias and more interested in promoting a stance or having their results published- they find the biggest statistic they can and throw it at people who don’t have time to look deeper, or lack an understanding of how the numbers work.

    Below is a non-baboon, mathematical model that positively links the acellular pertussis vaccination’s lack of ability to prevent colonization and transmission to the ever-increasing number of pertussis cases in the U.S. and U.K. since the 1980s:

    http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0382-8

    Your blanket defense of asking me to give you a better alternative is distracting, weak and off topic. I’m talking about how cocooning is in itself counterproductive to the cause of preventing the spread of pertussis. I haven’t said to stop using the pertussis vaccine on pregnant women in their third trimester. I’ve only said that cocooning will cause more harm than good, and the above link is your non baboon evidence that it is mathematically probable.

    New vaccines are on the way and I hope for them probably more than you do because I believe you and those like you have misdirected good intentions regarding pertussis cocooning that are very likely to be causing irreparable harm to some of those individuals unlucky enough to be affected by asymptomatic transmission.

    Also, your last paragraph is headlined “This information has since led to numerous ACIP pertussis vaccine recommendations.” What information are you referring to when you step back to 2008 immediately after linking and talking about 2013 and 2015 studies in your prior paragraph?

    Like

  11. Lawrence
    February 25, 2016 at 9:18 am

    I think her point of offering an alternative has great merit – you have done nothing but ask for better vaccines – which are currently in the pipeline.

    In the meantime, what do we do?

    Like

  12. David Mills
    February 25, 2016 at 9:53 am

    I never once asked for a better vaccine. I want her and others to stop misrepresenting this vaccines capabilities. This vaccine does not cocoon. Research has shown us that trying to cocoon with this vaccine is counterproductive and it is very highly probable that it intensifies pertussis outbreaks to attempt to cocoon with this vaccine. Vaccines do not work on a one prevention method fits all model, this campaign to try to cocoon your loved ones from pertussis is a dangerous lie that ignores science..

    Like

  13. Lawrence
    February 25, 2016 at 10:03 am

    Okay, then explain, in detail, your alternative, since you appear to have done the research.

    Like

  14. Chris
    February 25, 2016 at 11:45 am

    Mr. Mills, it is okay that you don’t like the DTaP and Tdap. But you need to provide an alternative, because if you are not part of the solution then you are part of the problem. Pertussis tends to kill infants, we want to prevent that.

    Again for the third time: what is your verified method for protecting infants and children from pertussis without the use of the present vaccines?

    Like

  15. David Mills
    February 25, 2016 at 2:57 pm

    I haven’t said to stop vaccinating pregnant women or infants as a means of protection. Those are strategies that can continue to persist until we have a better vaccine. I said not to cocoon because that method is not protecting infants and at risk populations. Instead of cocooning, continue to encourage the use of excellent sanitation and hygiene practices while maintaining your capability to see and avoid.

    You can say, “Aunt Jane, I know you want to see baby Michael, but I think we should wait until that cough goes away.” Because 30 year old Aunt Jane is most likely not going to have a traditional medically diagnosed case of Pertussis, even if she was exposed to it and had the bacteria. But, without the vaccine she will be more likely to at least have some symptoms of an illness and you won’t risk her sneezing in your house and leaving some bacteria that your at risk baby or senior citizen grandpa picks up. If she’s a good Samaritan and she feels something like a cold then she won’t go out into public with it either. If Aunt Jane happens to work at the daycare or nursery at her church, then she won’t decide to walk in there either. Unless, she is completely unaware that anything is wrong because of asymptomatic transmission permitted by the unnecessary vaccination of an adult who was convinced that they were protecting their nephew.

    Like

  16. Chris
    February 25, 2016 at 4:03 pm

    Please provide verifiable documentation that “Instead of cocooning, continue to encourage the use of excellent sanitation and hygiene practices while maintaining your capability to see and avoid” is sufficient, especially for an airborne infection.

    Like

  17. David M
    February 25, 2016 at 4:58 pm

    Please provide verifiable documentation that Pertussis is an airborne infection.

    Like

  18. Chris
    February 25, 2016 at 9:12 pm

    How about the baboon study you posted, the one titled “Airborne transmission of Bordetella pertussis demonstrated in a baboon model of whooping cough.”

    From my quick PubMed search there is also:

    J Infect Dis. 2012 Sep 15;206(6):902-6. doi: 10.1093/infdis/jis443. Epub 2012 Jul 17.
    Airborne transmission of Bordetella pertussis.

    Infect Control Hosp Epidemiol. 1998 Dec;19(12):918-23.
    Detection of Bordetella pertussis and respiratory synctial virus in air samples from hospital rooms.

    Like

  19. David M
    February 25, 2016 at 10:32 pm

    I never posted that study, I posted 2 others by the same person, but I knew that you would find it before I asked. Although I never posted it, it is by the same person, Dr. Warfel. It may be helpful for you to know more about him. He is an MD, Micro-Biologist who graduated from Georgetown and was a Research Fellow with the FDA for 5 years from December 2003 until 2010 at which point he began to work for the FDA from 2010 until last August in 2015. He also won the 2014 Maurice R. Hilleman Early-Stage Career Investigator Award from the National Foundation for Infectious Diseases. He went to Big Pharma in August of 2015. Regardless of his current employer, he has earned his place as a big deal in the scientific community for subject we are talking about, you can read more about him here:

    https://www.linkedin.com/in/jmwarfel

    Unfortunately, it’s become apparent that you haven’t actually read the studies you want to use as evidence or the ones I posted. As someone who has gone out of his way to be transparent, thorough and clear. I’m a little put off that you are posting so haphazardly. I strongly urge you to pay this subject the respect it deserves and consider the evidence. I’ll be the first to say that humility can often be a stumbling block towards personal and professional growth.

    The first study that popped up in your PubMed search is the same exact study by Dr. Warfel that you claimed I posted in the prior sentence.

    The second study that popped up in your PubMed search says that pertussis traveled UP TO 4 meters, not as far as the 7 meters that RSV traveled in the same study.

    The CDC also definitively groups Pertussis as droplet and not airborne. But, I’m not always a big fan of the CDC so I don’t mind if you agree that it’s probably not the best source to use. You can find it here:

    http://www.cdc.gov/hicpac/2007IP/2007ip_part3.html

    So, I’ll use your second source that you didn’t read, which says Pertussis travels up to 4 meters.

    If 30 year old Aunt Jane gets colonized with pertussis she will by all scientific reason be fine (she is not going to die), and we are better off if she is not first vaccinated. Because, if she does receive the unnecessary acellular pertussis vaccination because she has been convinced that cocooning was supposed to protect her nephew after reading a purposely misleading statistic. Aunt Jane will be asymptomatic and present a significantly increased risk to her nephew when she is invited into our agreed upon and scientifically tested 4 meter radius to visit.

    Personally, I’d prefer to know that she is sick and ask her not to come over. I’d tell her I loved her and she’d get another chance to hang out with Baby Michael sometime after her cold had cleared up.

    Liked by 1 person

  20. David M
    February 25, 2016 at 10:38 pm

    I apologize, I made a typo, I didn’t mean to type MD up there.

    Like

  21. Chris
    February 25, 2016 at 11:03 pm

    “The CDC also definitively groups Pertussis as droplet and not airborne.”

    So? Coughing produces droplets. If someone is asymptomatic then they are not coughing and spreading droplets. It is still better to make sure all that can be given the Tdap receive it.

    Like

  22. David M
    February 26, 2016 at 12:01 am

    Allergies, sneezing and such wouldn’t keep Aunt Jane’s colonized droplets at bay. Were you aware that Pertussis can actually survive outside of the body on clothing, glass and other dry surfaces for days? See this textbook if you weren’t:

    http://www.ncbi.nlm.nih.gov/books/NBK7813/

    When you step back from your emotional attachment to the message you’ve been promoting. It does not take a very imaginative person to figure out how acellular pertussis cocooning, a scientific improbability, and a strategy that is mostly promoted by a statistic that is purposely misleading in it’s presentation, is very likely a part of the problem.

    Your infant and other at risk populations are much safer knowing that Aunt Jane shouldn’t come over and the rest of the world is better off if she knows to stay out of the nursery and daycare. It’s been my experience that infants like to explore first with their eyes, second with their hands and third with their mouths…

    Like

  23. Chris
    February 26, 2016 at 2:12 am

    So what is your solution to Aunt Jane other than moving the goal posts? Allergies? In the mean time I present this:

    Aust N Z J Obstet Gynaecol. 2016 Jan 11. doi: 10.1111/ajo.12429. [Epub ahead of print]
    Pertussis vaccination coverage among Australian women prior to childbirth in the cocooning era: a two-hospital, cross-sectional survey, 2010 to 2013.

    Nurs Womens Health. 2015 Oct-Nov;19(5):402-9. doi: 10.1111/1751-486X.12231.
    An Evidence-Based Protocol for Protecting Newborns From Pertussis.

    Pediatr Infect Dis J. 2015 Nov;34(11):1244-9. doi: 10.1097/INF.0000000000000873.
    Influenza and Pertussis Vaccination Among Pregnant Women and Their Infants’ Close Contacts: Reported Practices and Attitudes.

    Pediatrics. 2015 Jun;135(6):e1475-82. doi: 10.1542/peds.2014-3925. Epub 2015 May 11.
    Strategies to decrease pertussis transmission to infants.

    Hum Vaccin Immunother. 2015;11(7):1744-7. doi: 10.1080/21645515.2015.1038442.
    Prevention of pertussis through adult vaccination

    Hum Vaccin Immunother. 2015;11(5):1165-72. doi: 10.1080/21645515.2015.1019188.
    Maternal uptake of pertussis cocooning strategy and other pregnancy related recommended immunizations.

    Vaccine. 2015 May 5;33(19):2213-20. doi: 10.1016/j.vaccine.2015.03.045. Epub 2015 Mar 27.
    Cost-benefit of the introduction of new strategies for vaccination against pertussis in Spain: cocooning and pregnant vaccination strategies.

    Scanning the abstracts reveal the problem is not vaccinating enough to create a real “cocoon.” The last link is very interesting.

    Like

  24. Lawrence
    February 26, 2016 at 12:19 pm

    I’m still confused as to what methods David would recommend to control the spread of Pertussis, outside of vaccinations.

    Like

  25. Andrew
    February 26, 2016 at 1:46 pm

    Here’s my point of view Lawrence. You and Chris keep harping about a better method of protection. That isn’t the point. The point is that they are lying about the protection the vaccine offers and the cocooning method. Please explain why they just can’t tell the truth about the vaccine and still use it, but it wouldn’t be used in a dangerous way and parents wouldn’t be mislead?

    Like

  26. Chris
    February 26, 2016 at 1:59 pm

    Where did you come from Andrew? Are you yet another sock puppet?

    I think the point is that there is not enough coverage of the Tdap, which is what the studies I just posted show. Plus it is pretty much discussed in the above article, perhaps you should read it instead of creating more identities. Now, Andrew, you get to answer the question that Mr. Mills seemed to stumble on:

    What is your proven way to prevent pertussis in babies and young children? Please provide PubMed indexed studies by reputable qualified researchers that your method actually works.

    Like

  27. Andrew
    February 26, 2016 at 2:06 pm

    Where did I come from? Where did you come from?
    Sock puppet? I don’t understand?

    You didn’t answer my question. Why do they have to lie about it?

    Like

  28. Chris
    February 26, 2016 at 2:08 pm

    The answer you want is in the above article. I suggest you read it before accusing anyone of lying.

    Like

  29. Andrew
    February 26, 2016 at 2:08 pm

    You say the vaccine is not perfect but there is nothing better. That does not explain why they have to provide misleading information which, ironically is very dangerous and could actually promote the spread of disease.

    Like

  30. Andrew
    February 26, 2016 at 2:10 pm

    So you are disputing the very first study that David supplied?

    Like

  31. Chris
    February 26, 2016 at 2:37 pm

    Try reading the comments about David’s first study. We were saying it was not as relevant as he thought.

    Now how is this lying (direct quote from the above article):

    The results showed that immunity waned to 75% after one year, 68% after two years, 35% after three years and 12% after the fourth year with a slightly higher estimate among one brand than the other. Then in 2015, another study investigated Tdap effectiveness among adolescents who received only acellular pertussis vaccines and found 73% effectiveness one year after vaccination, 55% effectiveness one to two years after vaccination, and 34% two to four years after vaccination.

    You really need to read and understand why the article has “the good, the bad and the ugly” phrase in the title.

    By the way the biggest lie from you and your many knitted friends is that getting pertussis provides permanent immunity. Like many bacterial infections the immunity provided can wear off in as few as five years:
    Pediatr Infect Dis J. 2005 May;24(5 Suppl):S58-61.
    Duration of immunity against pertussis after natural infection or vaccination.

    Now, again, please provide your method of protecting babies and young children from pertussis with supporting verifiable evidence that it works.

    Like

  32. Andrew
    February 26, 2016 at 2:50 pm

    Wow, you still won’t answer the question and instead misdirect. I never said getting pertussis provides permanent immunity.

    This obviously isn’t the place for an honest discussion. I’ll be moving on.

    Like

  33. reissd
    February 26, 2016 at 3:04 pm

    I think there is evidence that casts doubt on cocooning as a protective strategy. Including the baboon study. But that doesn’t make it a lie: when there is mixed evidence, experts have to draw conclusions and make a best-judgment recommendation, generally in condition of uncertainty. That’s not a lie.

    Aunt Jane may have milder symptoms if she is vaccinated – which I, at least, consider a good thing: I don’t want Aunt Jane’s ribs broken from coughing, and I don’t want her suffering for months, even if she doesn’t die. But it’s probably justified and important to limit access of anyone outside the home with upper respiratory symptoms to baby – after all, there are a number of serious diseases that start out looking like a cold – and as pointed out, coughing more may make Aunt Jane more contagious, not less. In other words, while I don’t think there’s a good case to insist that every casual visitors be vaccinated, there is no good case that it hurts, either. And there is some evidence that higher rates of vaccination in the community reduce outbreaks, protecting everyone, which for me is reason to want as many people as possible vaccinated.

    That said, for protecting newborns, it seems to me vaccinating in pregnancy is more important.

    Like

  34. Andrew
    February 26, 2016 at 4:20 pm

    Thank you reissd. If there is any question that cocooning could be risky, then one must side on that of caution and not the other. And I believe it is a lie when they promote this as gospel as heavily as they do, without mentioning there is evidence to the contrary. It’s not all of the information available and very misleading to parents. It could very well put babies at unnecessary risk when parents are actually following recommended guidelines, and being proactive to protect their babies.

    Like

  35. reissd
    February 26, 2016 at 4:25 pm

    I’m afraid I disagree. I read it as they have some evidence of asymptomatic transmission and some evidence that cocooning and vaccinating helps. They need to recommend one side or the other – assess the risks. The concerns about transmission are not secret. In the Q&A about pertussis, the CDC mentions them: “Since pertussis spreads so easily, vaccine protection decreases over time, and acellular pertussis vaccines may not prevent colonization (carrying the bacteria in your body without getting sick) or spread of the bacteria, we can’t rely on herd immunity to protect people from pertussis.” http://www.cdc.gov/pertussis/about/faqs.html

    But on balance, they have concluded that the risk is higher without cocooning than with. You can disagree with their assessment – but that doesn’t make it a lie, and they are supposed – it’s their job – to make a recommendation even in conditions of uncertainty.

    Like

  36. Andrew
    February 26, 2016 at 4:46 pm

    So you don’t believe it is dangerous to get vaccinated, carry the bacteria, not get sick and show symptoms, and then visit with babies? All the while the parents feel great about you visiting with baby because you were vaccinated.

    I want to make sure I understand where you are coming from.

    Like

  37. reissd
    February 26, 2016 at 4:50 pm

    I’m pointing out that they had to decide what is more risky – the possibility of that happening, v. the possibility of an unvaccinated person who is more likely to get sick passing the disease in the early stages, before serious symptoms are present, and the effect of more unvaccinated people in the community – increasing the likelihood of outbreaks. They recommend cocooning because they still estimate that the later risks are larger than the previous risk. You are emphasizing one risk only. They have to decide, in conditions of uncertainty, what to recommend. No lie in making the best recommendation they can, according to their best judgment.

    Like

  38. Andrew
    February 26, 2016 at 4:53 pm

    reissd, but a non-vaccinated person is not carrying the bacteria so less of a risk then a recently vaccinated carrying the bacteria with no symptoms.

    Like

  39. Andrew
    February 26, 2016 at 4:55 pm

    And btw, it is lying if they don’t tell the whole truth. You mentioned with a link the CDC admits it but they don’t market that information, so parents don’t know all of the truth to make their own best decision.

    Like

  40. reissd
    February 26, 2016 at 4:57 pm

    What do you base the claim of a non-vaccinated person not carrying the bacteria on? Of course an unvaccinated person can carry the bacteria. They can be asymptomatic or have early and unidentifiably symptoms.

    And they always provide partial information in the short version articles because it’s impossible to address all the complexities in them. They’re supposed to be short and accessible. They provide the information in an easy to find place – pertussis FAQ – which anyone who wants more information would read. Nothing hidden.

    Like

  41. Andrew
    February 26, 2016 at 5:03 pm

    Ok – so a non-vaccinated person can carry the bacteria.
    Who is more likely to carry it, a recently vaccinated or non-vaccinated?

    Can you show my the FAQ where the information is available? I would like to have access to it. If you know where it is.

    Like

  42. reissd
    February 26, 2016 at 5:08 pm

    I don’t know that there are numbers. The baboon study is still, I think, our main source of information about carriage by the vaccinated – and there they intentionally infected the baboons. I don’t think we have data on how common it is. If any other participant knows differently, please correct me.

    Like

  43. reissd
    February 26, 2016 at 5:10 pm

    That’s why I really do see this as a situation of substantial uncertainty.

    Like

  44. Andrew
    February 26, 2016 at 5:37 pm

    Thanks for your time. Good information.

    Like

  45. kato
    February 29, 2016 at 8:13 pm

    I am very interested in this topic and am doing research on vaccines for a college course. I would like to get as many opinions on the matter as possible. If everyone could please take this survey and share it with your friends it would be very beneficial! Thank you!! https://www.surveymonkey.com/r/Y5HC79Q

    Like

  46. March 7, 2016 at 2:25 am

    Hi, this post is truly nice and I have learned lot of things from it about article. thanks For sharing post.. I was looking for some pertussis vaccine information today when i noticed that you have a list of vaccine on the choose well section of pertussis vaccine.
    The reasons me mailing is to let you know that.I run vaccine schedule related website http://bit.ly/1QB1lIV we provide lots of vaccine notification and more. All of your advice is based on vaccine.
    It,d be great if you would consider adding a link to my site on your resource page.

    Either way have a great day and keep up good work!
    regards,

    Like

  1. No trackbacks yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: