Last Updated: 11/29/2016
The pertussis enigma: reconciling epidemiology, immunology and evolution – Matthieu Domenech de Cellès, Felicia M. G. Magpantay, Aaron A. King, and Pejman Rohani, in: Proc Biol Sci. 2016 Jan 13
“Routine Tdap did not prevent pertussis outbreaks.” – Nicola P. Klein, Joan Bartlett, Bruce Fireman, Roger Baxter; Pediatrics, March 2015 (Waning Tdap Effectiveness in Adolescents) http://pediatrics.aappublications.org/content/early/2016/02/03/peds.2015-3326
While the vaccine industry continues to try to blame whooping cough outbreaks on those who chose not to use the product, claiming lack of herd immunity, the scientific evidence shows the vaccine is not working as planned.
Pertactin-Negative Bordetella pertussis Strains: Evidence for a Possible Selective Advantage. Martin SW, Pawloski L, Williams M, et al, Clin Infect Dis. 2015;60:223-227.
“Patients who had received at least one dose of vaccine had a significantly higher odds of having PRN- B pertussis compared with unvaccinated patients” – link to study summary on Medscape
UC Berkeley Head Epidemiologist on the Comeback of Pertussis, Summer 2014: “You can be immunized and protected against getting the disease, pertussis, but still have the organism in your nose and throat and spread it to others. Or you can have a very mild illness that is caused by pertussis that causes you to cough, and thereby infect others. So the immunity is not 100 percent from the pertussis vaccine. And what it means is any kind of herd immunity—the way we see, for example, much more powerfully with measles—really can’t be relied upon.”
November, 2014 Outbreak of whooping cough in Falmouth, Massachusetts: All were vaccinated.
- NOTE: There is no philosophical exemption available in Massachusetts, despite solid testimony in 2011 in support of such an conscientious exemption.
Bordetella pertussis Infection Exacerbates Influenza Virus Infection through Pertussis Toxin-Mediated Suppression of Innate Immunity (Ayala, 2011)
Above is from: Meeting of the Board of Scientific Counselors, Office of Infectious Diseases Centers for Disease Control and Prevention Tom Harkins Global Communication Center Atlanta, Georgia December 11-12, 2013 (link to minutes: http://www.cdc.gov/maso/facm/pdfs/BSCOID/2013121112_BSCOID_Minutes.pdf)
- 7/9/2014: Whooping Cough in Windham County: Of the 11 confirmed cases, 10 were vaccinated. (Boston.com). Note: this statistic has been CONFIRMED by the Vermont Department of Health.
- Let’s take a look at the Proceedings of the National Academy of Science, 2014 baboon study. In this study, vaccinated animals asymptomatically carried the infectious bacteria for 42 days, longer than any of the other groups studied (including infected but unvaccinated animals). The infected but unvaccinated animals in the study were shown NOT to carry the bacteria upon reinfection and are therefore not infectious. So, the whooping cough vaccine fails to prevent infection & transmission in animal testing.
- Implications – 1. Did health officials know Pertussis vaccine does not confer herd immunity? If so, why did they keep blaming the unvaccinated as vaccinated child can pass the bacteria as well? – 2. If they did not know Pertussis vaccine does not confer herd immunity- how can they claim to be scientific where such a basic trait of the vaccine was missed for 70 years? And why they still blaming the unvaccinated after finding this out?
2012 Vermont Outbreak
(NOTE: West Virginia, a state with no philosophical or religious exemptions, also experienced a pertussis outbreak in 2012. http://www.dhhr.wv.gov/oeps/disease/Documents/WV_HAN_59.pdf). In 2012, those filing vaccine exemptions for their children were blamed for an expected whooping cough outbreak in Vermont after other states began to see the expected cyclical rise in cases. This was misinformation used in at attempt to remove vaccine exemptions from VT parents. http://www.unionleader.com/apps/pbcs.dll/article?AID=/20121007/NEWS12/710079917/0/NEWHAMPSHIRE0303&template=printart
So what are the facts on this 2012 whooping cough outbreak?
It is very clear that poor vaccine performance (“waning immunity”) and not vaccine exemptions are the cause.
The Vermont Government has developed specific recommendations for the evaluation, management and treatment of suspected cases of whooping cough. These recommendations include treatment with antibiotics regardless of vaccination status and exclusion of patients from work, school or other public contact until 21 days after onset of cough or until 5 days of antibiotics have been consumed (more).
Acellular pertussis vaccination enhances B. parapertussis colonization (more). http://web.archive.org/web/20140328101822/http://www.cidd.psu.edu/research/synopses/acellular-vaccine-enhancement-b.-parapertussis …
6/15/2014: Of the 621 people who’ve had the disease in San Diego County this year, 527 had the six shots necessary to be up to date with their pertussis vaccine (UPI)
4/14/2014 – A study by NSW researchers has found almost 80 per cent of whooping cough cases analysed were caused by a mutated bacteria that had stopped producing pertactin – one of the three key proteins targeted by the vaccine.
“Clearly it is a red light in terms of how well the vaccination works,” said Peter McIntyre, study author and director of the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases.
“The fact that they have arisen independently in different countries suggests it’s a response to the vaccine,” said Ms Lam, of the University of NSW school of biotechnology and biomolecular sciences.
Study: Rapid Increase in Pertactin-deficient Bordetella pertussis Isolates http://wwwnc.cdc.gov/eid/article/20/4/13-1478_article.htm
February 2013 Statement made at the National Vaccine Advisory Committee meeting:
“Dr. Clark also did not believe the problem is related to unvaccinated children, because it occurred nationally and is widespread, and because the majority of those affected were vaccinated. CDC is discussing whether a single repeat Tdap dose would be effective. There is potential for developing new or improved vaccines to better control pertussis in the long term, Dr. Clark concluded.” – From, Pertussis Epidemiology and Vaccination in the United States—Thomas Clark, M.D., M.P.H., CDC – found on page 8 here. http://www.hhs.gov/nvpo/nvac/meetings/pastmeetings/2013/feb2013_certified_minutes.pdf
Proceedings of the National Academy of Science, 2014 study: Whooping cough vaccine fails to prevent infection & transmission in animal testing. In this study, vaccinated animals asymptomatically carried the infectious bacteria for 42 days, longer than any of the other groups studied (including infected but unvaccinated animals). The infected but unvaccinated animals in the study were shown NOT to carry the bacteria upon reinfection and are therefore not infectious.
According to expert Dr. James Cherry, the universal use of pertussis vaccines has been associated with genetic changes in circulating B. pertussis strains. In Pertussis: Challenges Today and for the Future (http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1003418), Dr. Cherry states that,“There are five possible reasons for the resurgence: 1) genetic changes in B. pertussis; 2) a decrease in vaccine efficacy; 3) a more rapid occurrence of waning immunity; 4) increased recognition and reporting of pertussis; and 5) newer laboratory diagnostic tests.“ – Read article published July 25, 2013 (http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1003418#s2 ).
See also our related posts:
- Straight Talk About Whooping Cough http://www.vaxchoicevt.com/2012/12/18/1569/
- Info. About the Tdap Vaccine http://www.vaxchoicevt.com/2012/12/15/information-about-the-tdap-vaccine-being-recommended-for-all-vt-adults/
Whooping Cough cannot be eradicated by childhood vaccination alone (source – http://bit.ly/jQgkUa).
“The advantages and disadvantages of routine immunization of infants against whooping cough have been debated since 1933” – see: http://www.ncbi.nlm.nih.gov/
Will more vaccines work to “defeat” Whooping Cough?
“In the case of natural whooping cough immunity, ACT or adenylate cyclase toxin, forms the basis of the initial immune response, and that front line immune response is crucial for removing the bacteria on reinfection. No vaccine can have ACT in it, because it’s made in the body, as part of the disease process and it seems you can’t make ACT in a test tube. The immunity created from a vaccine misses this step out. So when a vaccinated person contracts pertussis again, the bacteria can get a good hold, because there is nothing to stop it from doing so. The immune system will NOT respond to ACT in the future, because the programme has been set by the first contact which was the needle, not the bacteria.” Read more http://www.beyondconformity.co.nz/BlogRetrieve.aspx?PostID=297920&A=SearchResult&SearchID=5388533&ObjectID=297920&ObjectType=55(see%20also%201996%20VT%20Outbreak%20Facts%20and%20other%20posts%20on%20whooping%20cough).
Pertussis outbreaks occur in highly vaccinated groups and that there is little relationship between vaccination rates and Pertussis outbreaks. Nevertheless, a chart has been used to try link Pertussis outbreaks to non-medical exemption availability.
March 2013 study Results: “findings add to the growing body of evidence that DTaP protection begins to wane after vaccination, thereby increasing the number of people susceptible to pertussis.”
The study included 224,378 Minnesota children who had all five doses and 179,011 Oregon youngsters who were fully vaccinated. In the 6 years after vaccination, there were 458 pertussis cases in the Minnesota group and 89 in the Oregon group.
Pertussis rates rose each year for kids in both states. In Minnesota, the cases rose from 15.6 per 100,000 population the first year to 138.4 per 100,000 population in year 6. For Oregon the pertussis incidence was 6.2 per 100,000 in year 1 and 24.4 per 100,000 in year 6. Researchers also found increases in risk ratios for both states.
The group concluded that the findings strongly suggest waning vaccine immunity. They noted that although Minnesota and Oregon had different pertussis rates during the study period, both had similar increases in risk ratios.
The findings add to the growing body of evidence that DTaP protection begins to wane after vaccination, thereby increasing the number of people susceptible to pertussis. “This growing pool of susceptible persons helps to explain the emergence of an increased burden of disease among 7- to 10-year-olds, a group that previously had a low risk of disease, presumably due to partial or complete vaccination with whole-cell vaccines,” they wrote.
Because pertussis is contagious, in years of increased circulation, even a modest drop-off in protection can have a big impact, they noted.
Though many factors may be driving the national resurgence of pertussis, the striking and sudden increase in disease among 7- to 10-year-old that began in 2005 and a strong cohort effect seen in national surveillance data suggest that the major factor is the early waning immunity from acellular vaccines.
More studies are needed to estimate vaccine effective and to explore how long the Tdap booster protects those who were vaccinated. Because better vaccines are on the distant horizon, making the most of the current vaccines offers the best protection against pertussis, they wrote.
See: Tartof SY, Lewis M, Kenyon C, et al. Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013 Mar 11;131(4):e1047-52 [Abstract]
See also: Jul 19, 2012, CIDRAP News story “CDC: Pertussis numbers suggest vaccine protection gap”
Feb 7 CIDRAP News story “Researchers find first US evidence of vaccine-resistant pertussis”
Is “Cocooning” (vaccinating all adults and others in contact with babies and children) The Right Approach?
Current CDC position on Pertussis control can be found here. It should be noted that “ACIP concluded that cocooning alone is an insufficient strategy to prevent pertussis morbidity and mortality in newborn infants.”
November 2011: Australian government decision to end subsidies for pertussis cocooning, citing “uncertain clinical effectiveness of the cocooning strategy and likely high and highly uncertain cost effectiveness.” Read their Report.
From the report:
The PBAC helps decide whether and, if so, how medicines should be subsidized in Australia. It considers submissions in this context. A PBAC decision not to recommend listing or not to recommend changing a listing does not represent a final PBAC view about the merits of the medicine. A company can resubmit to the PBAC or seek independent review of the PBAC decision.
“The PBAC noted that no evidence was presented in the submission regarding vaccine efficacy in preventing subclinical pertussis infection, as opposed to preventing symptomatic pertussis illness in adults. The PBAC considered that the potential for adults with subclinical infection to transmit pertussis to vulnerable infants increases uncertainty associated with vaccine efficacy and the effectiveness of a cocooning strategy”
“The submission did not provide clinical evidence on the comparative efficacy in preventing pertussis in susceptible infants when the vaccine is provided to parents shortly after birth.”
There is “no commonly agreed serological surrogate for protection against pertussis,”
“The PBAC considered that the clinical effectiveness of the requested listing – to reduce transmission of pertussis from an infected parent to a susceptible infant – was uncertain as no evidence from randomised controlled trials was presented in the submission for this indication. Rather, the submission provided an estimate of the proportion of infant cases of pertussis that are the result of contact with an infected parent as a proxy for rate of transmission.”
“The PBAC therefore rejected the submission on the basis of uncertain clinical effectiveness of the cocooning strategy and likely high and highly uncertain cost effectiveness.”
Do we have alternatives beyond vaccines to stay healthy?
Vermont is home to more alternative medical practitioners than anywhere else in the US. Certainly there are may be other health choices that folks can make to stay healthy, and we would like to see these modalities explored.
Note: If you or someone you care about may have pertussis, see our post on The Vitamin C Treatment of Whooping Cough by Suzanne Humphries, MD for some guidance on what you might do to help them. This website is NOT for medical advice, but Chiropractic and Naturopathic doctors, Nutritionists, Herbalists and Homeopaths all have something to offer your health.
Are VT’s vaccine programs effective in controlling the disease?
I and other members of the Vermont Coalition for Vaccine Choice wrote to VT legislators in 2012, outlining the many studies and articles that have been published over the years, in several countries, showing problems with the efficacy of the pertussis vaccine. In fact, whooping cough outbreak is perhaps being caused by “a selective advantage in vaccinated human populations” (see: http://www.ncbi.nlm.nih.gov/
We recommended at that time that vaccine manufacturers should be queried and held to a higher burden of proof as to the true performance of their products. The following information comes from recent studies with regards to the poor performance of the Pertussis vaccine in controlling disease and was shared with Vermont legislators in 2012:
Early waning of immunity might be contributing to increasing population-level susceptibility. http://jama.jamanetwork.com/article.aspx?articleid=1362036
“In early 2010, a spike in cases appeared at Kaiser Permanente in San Rafael, and it was soon determined to be an outbreak of whooping cough — the largest seen in California in more than 50 years. Witt had expected to see the illnesses center around unvaccinated kids, knowing they are more vulnerable to the disease. “We started dissecting the data. What was very surprising was the majority of cases were in fully vaccinated children. That’s what started catching our attention,” said Witt. To figure out just how well the vaccine was working, Witt and his colleagues collected information on every patient who had tested positive for pertussis between March and October, 2010. Of the 132 patients under age 18, 81 percent were up to date on recommended whooping cough shots and eight percent had never been vaccinated. The other 11 percent had received at least one shot, but not the complete series. The rate of cases for each age, two through 18 years old, peaked among kids in their pre-teens. Among fully immunized kids, there were about 36 cases for every 10,000 children two to seven years old, compared to 245 out of every 10,000 kids aged eight to 12.” and “…the vaccine is effective about half of the time for all kids, and just 24 percent of the time in the eight to 12 year old age group. “It’s likely if we move doses around we’d shift the burden of disease, but not necessarily reduce it,” A spokesperson for GSK, one of the pertussis vaccine makers, wrote in an email to Reuters Health that studies conducted by the company have shown the vaccine is about 78 percent effective in warding off disease up until the age of six years. GSK has never studied the duration of the vaccine’s protection after the shot given to four- to six-year-olds, the spokesperson said.”
“Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population.”http://www.ima.org.il/imaj/ar06may-2.pdf
“An important issue is whether vaccination has selected for the ptxP3 strains. Several lines of evidence support this contention.” “Based on mathematical modeling, vaccines designed to reduce pathogen growth rate and/or toxicity may result in the evolution of pathogens with higher levels of virulence” The authors “propose that waning immunity and pathogen adaptation have contributed to the resurgence of pertussis, although other factors such as increased awareness and improved diagnostics have also played a role.”http://wwwnc.cdc.gov/eid/article/15/8/08-1511_article.htm
“Pertussis is an infectious disease of the respiratory tract caused by Bordetella pertussis. Despite the introduction of mass vaccination against pertussis in Finland in 1952, pertussis has remained an endemic disease with regular epidemics.” and “During the last decade, the number of pertussis cases has increased in countries with high vaccination coverage rates including Finland.”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1233997/
“Reemergence of pertussis has been observed in many countries with high vaccination coverage. In the United States, reported cases of pertussis in adolescents and adults have increased since the 1980s, despite increasingly high rates of vaccination in infants and children. At the same time, clinical B. pertussis isolates have become antigenically divergent from vaccine strains. This observation has raised the question of whether vaccination has caused selection for the variant strains, and whether the reemergence of pertussis in vaccinated populations is due to vaccination not protecting against these antigenic variants as effectively as it protects against vaccine type strains. On the other hand, vaccine-induced immunity wanes over time, and pertussis is not only a childhood disease but also a frequent cause of prolonged illness in adults and adolescents today.”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294326/
Finally, here is a study published in the Journal of the American Medical Association showing that despite vaccine coverage of 98% both pertussis and para-pertussis outbreaks appeared in Finland. Their conclusion was that, “Bordetella infections are common in an immunized population, and B parapertussis infections apparently are more prevalent than previously documented.”http://jama.ama–assn.org/content/280/7/635.full
Read more about pertussis here.