The Skinny on Pertussis, Vaccines and Enforced Mandates


Meryl Nass, M.D.
March 10, 2019

Pertussis is a common bacterial infection that is uncommonly diagnosed, with probably over a million cases yearly in the US.  Worldwide there were an estimated 24 million cases, per CDC.[1]

"The
confirmation of Bordetella pertussis infection is still one of the most
difficult diagnostic challenges facing the clinician, particularly in
adolescents and adults"--from the textbook Vaccines."[2]

A
2006-7 survey in the Netherlands suggested that 9% of those over age 9 had had
pertussis in the past year.[3]  Other studies suggest that up to 26% of those
seeing a doctor for chronic cough had pertussis.  The bottom line is that because it is hard to
get a precise diagnosis, we do not really know how common pertussis is.  But it is common. 

It
is common because neither the disease nor the vaccine confer much immunity.  During the first year after a Tdap vaccination,
effectiveness is estimated about 67%, but by 4 years later effectiveness may be
only 9%.[4]  The WHO says,

The disease, caused by the bacterium Bordetella pertussis,
is endemic in all countries. Epidemic cycles have been occurring every 2 to 5
years (typically 3 to 4 years), even after the introduction of effective
vaccination programmes and the achievement of high vaccination coverage.[5]


Pertussis
circulates within the US at all times.
[6] 

Pertussis
causes a respiratory illness with cough that can last several months. There are
about 10 deaths yearly from pertussis in the US.[7]  It is most dangerous in young infants, who
are most likely to be infected by their older, previously vaccinated siblings.

Of
children diagnosed with pertussis aged 6 months to 6 years, only 10% had
received no pertussis vaccinations.[8]

The
only pertussis vaccines available in the US are the DTaP (for small children) and
Tdap (for those older than age 7).  Each
contains toxoids and antigens for 3 diseases: 
tetanus, diphtheria and pertussis. 
There is no individual pertussis vaccine.

DTaP
is recommended as a 5 dose series beginning at 2 months of age.  Tdap (which surprisingly contains considerably
lower doses of diphtheria and pertussis toxoids/antigens and (in one brand) tetanus
toxoid, is recommended as a single dose for 12 year olds, or for older
individuals who have not yet received it. 
It is recommended (off-label) for pregnant women during the latter part of
every pregnancy, although it has not been proven safe for them.[9]  The idea was to provide maternal antibodies to
newborns this way.


Yet
the WHO noted:
[10]

Pertussis remains an
important cause of infant death worldwide and continues to be a public health
concern even in countries with high vaccination coverage. Maternal antibodies do not appear to protect neonates from severe
pertussis
, and even for individuals with vaccine-induced immunity, the
initial antibody-mediated immune response to B. pertussis may minimize the toxic damage to both
epithelial and immune cells, but it has
limited impact on its subsequent circulation
among non-immunized children
and older individuals with waning immunity.

In
plainer language, this means two things:
  1. 1)  that
    vaccinating pregnant women to induce maternal antibodies is unlikely   to prevent
    severe pertussis in their exposed neonates, and
  2. 2)  that
    while recent vaccination is protective against pertussis disease,   because of
    short duration of protection, herd immunity can never be   achieved.


Furthermore,
it is now known that the vaccine confers protection against pertussis symptoms,
but fails to prevent infection by pertussis bacteria.  It seems hard to believe, but CDC
acknowledges this is the truth, below. 
The result is that vaccinated people are likely to spread pertussis,
because of the absence of significant symptoms.


From
CDC's 2018 pertussis recommendations:[11]

Studies in animal models have shown that acellular pertussis
vaccines protect against disease but not
against infection or transmission
of B. pertussis or the closely related
species, B. bronchiseptica....

... recent evidence suggests that vaccination with acellular
pertussis vaccines does not prevent transmission and therefore does not afford
indirect protection against pertussis

In contrast to tetanus and diphtheria, the incidence of reported pertussis in the United States has been
increasing despite high infant and childhood coverage with DTaP vaccines and
increasing Tdap coverage among adolescents

And
yet another problem: an FDA study found that vaccinated baboons who were then
exposed to pertussis developed asymptomatic illness, and spread infection much
longer than unvaccinated animals.[12]

It
should be apparent that how pertussis vaccinations impact the spread of pertussis
is unsettled.  In a tacit acknowledgement
of this, CDC responded to the issue of pertussis transmission in the healthcare
setting, but realized there was little they could offer. Among CDC's points to
consider:[13]

·       "Vaccinating healthcare personnel with Tdap is
not a substitute for infection prevention and control measures including post-exposure
antimicrobial prophylaxis.
·       There is no supportive evidence that additional Tdap
doses would prevent pertussis disease and transmission in a healthcare setting.
·       Vaccine effectiveness studies suggest the duration of
protection against pertussis afforded by Tdap vaccination in adolescents is
less than 4 years
·       Despite
high Tdap coverage and recent receipt of the vaccine, adolescents are
experiencing high rates of pertussis in the United States.

Clearly,
if extra pertussis vaccinations will not prevent pertussis in hospitals, they
will not prevent them in schools, or anywhere else.

We need better
vaccines.  We need safer vaccines.  A captive market has allowed vaccine
manufacturers to avoid developing products that work as expected.  



Strict mandates will not only disincentivize
improvements to vaccines, but open the door to newer, unsatisfactory vaccines
being added to the childhood schedule--and we will have no choice to refuse
them.


[1] https://www.cdc.gov/pertussis/fast-facts.html
[2] Edwards KM and
Decker MD. "Pertussis" in Vaccines, edited by Plotkin SA et
al., 6th edition. 2013.
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995730/
[4] https://www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf 
[5] https://www.who.int/wer/2015/wer9035.pdf?ua=1
[6] https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf
[7] https://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2018-508.pdf
[8] https://www.cdc.gov/pertussis/downloads/pertuss-surv-report-2018-508.pdf
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716252/
[10] https://www.who.int/biologicals/vaccines/pertussis/en/#
[11] https://www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf 
[12] https://www.pnas.org/content/111/2/787
[13] https://www.cdc.gov/vaccines/vpd/pertussis/tdap-revac-hcp.html
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Ignatius Albright
Ignatius Albright
3 years ago

Meryl,

It's so good to see you back and posting again! Either you've been really busy starting your business, or very little has gotten under your skin in the past year 🙂 I'm glad I still check this now and then to see if you're still posting. I've missed you and I suspect others have as well!

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