Whooping Cough Epidemic: Is Vaccination Refusal Playing a Part?

Sheri Reed

vaccinationDiagnoses of whooping cough started cropping up in California a few weeks ago. Over 2,100 cases of whooping cough have been confirmed in the state -- more than four times as many as last year -- killing seven babies. An epidemic has been declared, vaccinations are being strongly urged, and now more than 6,900 whooping cough cases are being reported in other states throughout the U.S.

Is whooping cough the next nationwide epidemic? And what about vaccinations? Do non-vaccinations play a part in making this the largest whooping cough outbreak since 1958?

According to an article in Mother Jones:

"Officials are still investigating the causes of the outbreak, but some have already suggested that the anti-vaccine movement could be at least partly to blame."

In an ABC News story, Dr. Blaise Congeni from Ohio’s Akron Children's Hospital said:

"California is the epicenter of vaccine refusal." Even though California requires that children be vaccinated from whooping cough before they attend school, Congeni says, "the requirement is waived if parents file a 'personal belief exemption' (PBE), which need not be based on religion or medical necessity."

Dr. Anatoly Belilovsky, New York board-certified pediatrician and expert in early diagnosis and a proponent for immunizations, is here with us today with some advice and suggestions about how to protect your children from this highly contagious and potentially fatal upper respiratory disease, also known as pertussis

Who is most at risk with the current epidemic of whooping cough?

Pre-vaccinated children under six months old are the most vulnerable to the disease because of both age (the younger the child, the higher the mortality and the chance of cerebral hemorrhage) and uncompleted (or not yet begun) primary vaccine series. The vaccine for whooping cough is a series of three shots, culminating when the child is around six months old.

Of course, anyone who has not been vaccinated against the disease is very much at risk. Even adults who were vaccinated as children but have not received boosters and are over the age of 65 are at a heightened risk. This is because the immunity given by the vaccination actually fades over time.

New moms and pregnant women are being told to get vaccinated to help protect their babies. If we already got a whooping cough shot when we were young, why should we get one again?

Antibody levels fade over time. What we think of as whooping cough epidemics -- ten or so reported cases -- are actually just the tip of the iceberg. We have always known that in any whooping cough epidemic, there are a number of confirmed cases -- those with easily-diagnosed classic presentation and positive labs -- but also a huge up tick in the number of people with chronic cough but nothing else. There is good evidence that all of these people with the chronic cough actually have whooping cough, although they go undiagnosed because, due to some lasting immunity from their childhood vaccinations, they present with such relatively mild symptoms.

The good news for those people is that their infection does act as a booster shot against future infections, for five to ten years -- at the cost, however, of three months of severe, unrelenting, largely untreatable cough for the sufferer, and the danger of severe disease for at-risk contacts. Adult boosters certainly prevent these episodes fairly well, but more importantly, they decrease the hazard of transmission via adults to infants. For that reason, new moms AND their partners should be sure to get booster shots, as should anyone who is in contact with children and babies.

What are the early signs of whooping cough?

Whooping cough is a really bizarre disease. The bacteria that causes it is very highly contagious, but it does not multiply in large numbers in the lungs, and it does not invade deep into the body. It causes the cough by depositing a long-acting toxin in the lining of the bronchi. The initial presentation of pertussis is a week of mild coughing. This is called the "catarrhal" phase. It is impossible to diagnose pertussis during this time with any degree of reliability and in a timely manner, but this time is the only chance to abort the infection with antibiotics. When the paroxysmal phase starts and the diagnosis is possible, it is too late to treat (though antibiotics will reduce time of contagiousness).

What steps can parents take to protect their kids from whooping cough (beyond immunizations, of course)?

It is my practice to start antibiotics in potentially exposed individuals with even mild coughs, especially if they are at high risk for complications. (Known exposed contacts are given antibiotics even when asymptomatic).

It is critical that parents get vaccinated for whooping cough, even if they had the shots as children. Otherwise, they could get a mild case of the disease and, without even knowing that they have it, transmit it to their children. Most parents know that they must have their children vaccinated, but not all parents think to get themselves vaccinated as well.

Clearly, the usual airborne infection precautions -- stay out of crowds, limit visits to immediate family, separate from symptomatic family members, hand washing and not sharing personal items -- apply as well.

This outbreak emphasizes the importance of vaccines. Whooping cough is a potentially fatal, yet entirely preventable disease as long as children and adults are kept current with vaccines.

What about parents who choose not to vaccinate?

Many parents who choose not to vaccinate their children may believe that there are alternative strategies to reduce risks -- breastfeeding, organic or raw/live food, vitamins to boost the immune system, etc.  And in fact, these efforts might yield some fractional, incremental reduction in risk (particularly with breast feeding). But to say that "healthy living" cuts the risk of death or permanent injury by, say, ten times, does not change the fact that universal vaccination cuts the risk by two or three orders of magnitude (by 100 to 1,000 times).

 The reason that I recommend vaccinations is there really are no other reliable methods of preventing extremely contagious diseases like whooping cough. 

Whether you vaccinate or don't vaccinate, are you concerned about whooping cough?


Image via lu_lu/Flickr

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