In the last 2 weeks I've had several patients come in to the office concerned about the whooping cough epidemic and the mandate by the Murrieta Valley Unified School District that all 7th to 12th grade students must have a current pertussis booster to be admitted to school in the fall. I'd like to take the opportunity to provide some information you won't hear anywhere else on the subject so that you can make an educated decision on the matter of this additional recommended vaccination.
California is in the midst of an infectious disease "epidemic" an epidemic caused by Bordetella pertussis - the bacterium that causes whooping cough. Whooping cough's primary clinical feature is the potential for a severe, lingering cough that can persist in many patients for weeks, if not months. The characteristic "whoop" is the sound caused by the rapid inhalation after a coughing spell. The disease is spread thorough the inhalation of respiratory droplets released into the air when an infected individual fails to cover their cough.
In the 1920s and 1930s, pertussis was an annual concern as a feared childhood killer. National annual infection rates were as high as 250,000 cases with as many as 9,000 deaths each year. In the 1935, health authorities introduced a combined vaccine against diphtheria, pertussis, and tetanus (DPT, now replaced with DTaP). The "health authorities" would have us believe that by 1976, in the United States, as a result of routine DPT vaccinations of children, pertussis in children had been virtually eliminated - there were only 1,010 cases reported that year. The reality is that the pertussis death rate had declined by 79% before the vaccine was introduced in 1935. In 1935 there were no compulsory immunization laws and it didn't get used much until the 1950's at which time the death rate had declined by about 99%.
The clinical symptoms of pertussis can be difficult to distinguish from those of other respiratory infections. Symptoms may appear at first similar to those of a common cold: runny nose or congestion, sneezing, mild cough. Fever is often not present. At three weeks post-infection, 97 percent of patients will have a cough, and in 72 percent the cough will be severe (paroxysms). After more than nine weeks, 52 percent will still have a cough symptom. The challenge arises when the infected individual, unaware that they have the disease, spreads it in the early stages. Not until weeks down the road, may the diagnosis of pertussis be made.
The diagnosis requires laboratory confirmation which is often not performed since the very duration of the cough is the most utilized diagnostic criteria. Diagnostic testing is of relatively low sensitivity, particularly later in disease. Treatment is often delayed due to late presentation of the patient or late recognition by practitioners. Although treatment is important to reduce spread of infection, it does not influence the clinical course of the disease. Prevention is the best option.
The key to prevention does not, in my opinion, include vaccination, but rather several simple approaches that improve host defenses - increased immunity. Well nourished individuals with properly functioning immune systems that take extra vitamin C and D during cold and flu season, practice frequent hand washing and basic "cover your cough" skills are at a low risk of contracting the disease in the first place.
Please keep in mind that the whooping cough vaccination is "piggy backed" with Diphtheria and Tetanus neither of which we are currently experiencing an epidemic. The vaccine caries with it, among other things, a multitude of preservatives and additives including, but not limited to, gelatin, casein, formalin (formaldehyde), ethylene glycol (antifreeze), latex, genetically modified yeast, and MSG. Formalin is a dilute formaldehyde solution. Nearly 50 studies have shown a link between formaldehyde exposure and leukemia and brain, colon and lymphatic cancer. Then they throw in the heavy metals mercury and aluminum. Thimerosal is the form of mercury used in vaccines. OK, I know, thimerosal has been removed form our childhood vaccines. Or has it? The truth is that it is now kept below a new lower level. And don't be fooled - mercury is still present in vaccines given to adults and in every flu vaccine!
This list of side effects associated with the vaccine comes directly from the CDC's handout on the DTaP vaccine. It is here provided verbatim.
Mild Problems (Common)
- Fever (up to about 1 child in 4)
- Redness or swelling where the shot was given (up to about 1 child in 4)
- Soreness or tenderness where the shot was given (up to about 1 child in 4)
These problems occur more often after the 4th and 5th doses of the DTaP series than after earlier doses. Sometimes the 4th or 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, lasting 1-7 days (up to about 1 child in 30).
Other mild problems include:
- Fussiness (up to about 1 child in 3)
- Tiredness or poor appetite (up to about 1 child in 10)
- Vomiting (up to about 1 child in 50)
These problems generally occur 1-3 days after the shot.
Moderate Problems (Uncommon)
- Seizure (jerking or staring) (about 1 child out of 14,000)
- Non-stop crying, for 3 hours or more (up to about 1 child out of 1,000)
- High fever, over 105oF (about 1 child out of 16,000)
Severe Problems (Very Rare)
- Serious allergic reaction (less than 1 out of a million doses)
Several other severe problems have been reported after DTaP vaccine. These include:
- Long-term seizures, coma, or lowered consciousness
- Permanent brain damage.
These are so rare it is hard to tell if they are caused by the vaccine.
The CDC handout goes on to discuss the National Vaccine Injury Compensation Program. "In the rare event that you or your child has a serious reaction to a vaccine, a federal program has been created to help pay for the care of those who have been harmed. For details about the National Vaccine Injury Compensation Program, call 1-800-338-2382 or visit the program's website at www.hrsa.gov/vaccinecompensation."
So what is the risk that your 7th through 12th grader will contract the disease and suffer serious long term damage, injury or death? Virtually zero! The disease is self-limiting in this age group. That means the cough runs its course and the immune system finally eliminates it. The only risk of serious issues arising as a result of the infection are found in the infant and senior populations. Simply practicing common sense and keeping the immunocompromised individuals away from anyone displaying cough or cold symptoms is enough to prevent the transmission of the disease to someone at higher risk.
The fact is that pertussis incidence is cyclical, even among fully vaccinated populations. Since the early 1980s, reported pertussis incidence has increased cyclically with peaks occurring every 3-4 years. We are at the peak of one of these cycles. We are going to see more cases this year, that's just the way it is!
The last thing I want to cover is a couple of very important facts. The state's new legislature does not go into effect until the Fall of the 2011-2012 school year, not this year. Most importantly, this new legislation does not supersede the state law that allows for exemptions. In California 3 exemptions are available, medical, religious and philosophical. All you have to do is sign the waiver available through the school and your child can attend school without the new "mandated" vaccine.