Why new parents (and almost-parents) need pertussis vaccines

I'm 38 weeks pregnant now. Two weeks ago, my husband and I both got Tdap vaccines — tetanus, diphtheria, and pertussis. This despite the fact that we've both gotten Tdaps relatively recently, within the last six years, thanks to a home renovation lifestyle that involves regular exposure to rusty nails.

So why re-up on the Tdap before the birth of our baby? It's all about the pertussis. Also called whooping cough, pertussis is particularly hard on infants. Pre-vaccine, it killed 4000 Americans every year, and most of them were new babies — and infections are on the rise in this country, so there's actually a reasonable risk of a newborn coming into contact with the bacteria that causes pertussis. But the larger problem is with the pertussis vaccine, itself. It doesn't have the staying power it once did. A little over 20 years ago, we switched the formulation for pertussis vaccines. There were good reasons for doing that — the "new" formula has fewer side effects. But it also doesn't seem to protect people as well for as long. In fact, the protection starts to wear off within a year of vaccination.

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The other problem with fake vaccine scares

It's not just that bad information on the "dangers" of vaccines is working to reduce the number of children getting vaccines — a fact that affects herd immunity. Now, there's evidence that the fake scares (and efforts to debunk them) are getting in the way of scientists publishing real evidence about actual problems with certain vaccines. These aren't the kind of broad "vaccines are poison" claims you're familiar with. Instead, we're talking about legitimate science documenting side effects that are usually very rare, but still have an impact on certain subsets of the population and need to be addressed.

Vaccine-resistant whooping cough found in Philadelphia

When we talk about the resurgence of childhood illnesses, we tend to focus on vaccine-resistant people as the primary cause. And it's true that a large population of un-vaccinated kids can give a disease like whooping cough a foothold in a community, and allow it to spread to kids who haven't been vaccinated yet or who can't be vaccinated for various medical reasons. But there's another facet to this story, as well. Some of the strains of bacteria that cause whooping cough are also resistant to the vaccine. Those strains have been found in Japan, France, and Finland. Last week, The New England Journal of Medicine reported on 12 cases of vaccine-resistant whooping cough in Philadelphia.

The whooping cough vaccine your children get may not work as well as the one you got as a kid

About 20 years ago, the United States and a few other countries started using a different pertussis vaccine than had been used previously. The change was in response to public fear about some very rare neurological disorders that may or may not have had a relationship to that older vaccine (it couldn't ever be proven one way or the other).

The vaccine we use today was created to get around any possible mechanism for those disorders and, along the way, ended up having lower rates of the less-troubling (and far, far more common) sort of side effects, as well. Think short-term redness, swelling, or pain at the site of injection.

The downside, reports Maryn McKenna, is that this new vaccine might not be as effective as the old one. In fact, scientists at the Centers for Disease Control, Kaiser Permanente Medical Center in San Rafael, Calif., and Australia's University of Queensland’s Children’s Medical Research Unit, are raising the possibility that a less effective vaccine could be part of why we're now seeing a big increase in pertussis outbreaks.

In the most recent research, a letter published Tuesday night in JAMA, researchers in Queensland, Australia examined the incidence of whooping cough in children who were born in 1998, the year in which that province began phasing out whole-cell pertussis vaccine (known as there as DTwP) in favor of less-reactive acellular vaccine (known as DTaP). Children who were born in that year and received a complete series of infant pertussis shots (at 2, 4 and 6 months) might have received all-whole cell, all-acellular, or a mix — and because of the excellent record-keeping of the state-based healthcare system, researchers were able to confirm which children received which shots.

The researchers were prompted to investigate because, like the US, Australia is enduring a ferocious pertussis epidemic. When they examined the disease history for 40,694 children whose vaccine history could be verified, they found 267 pertussis cases between 1999 and 2011. They said:

"Children who received a 3-dose DTaP primary course had higher rates of pertussis than those who received a 3-dose DTwP primary course in the preepidemic and outbreak periods. Among those who received mixed courses, rates in the current epidemic were highest for children receiving DTaP as their first dose. This pattern remained when looking at subgroups with 1 or 2 DTwP doses in the first year of life, although it did not reach statistical significance. Children who received a mixed course with DTwP as the initial dose had incidence rates that were between rates for the pure course DTwP and DTaP cohorts."

You can read the rest of the story at Maryn's Superbug blog

A key thing to remember: This is a nuanced theory that may or may not turn out to be right. But, if it does turn out that this vaccine isn't as effective as we want it to be, that's not a dark mark against vaccines, in general. Sometimes, medicine doesn't work as well as intended. It's a risk of medicine. And the fact that it's major research institutions pointing this possibility out, should give people some comfort in the scientific process. If doctors and organizations who promote childhood vaccination are all in the pockets of an evil conspiracy then there would be no reason why they'd ever do research like this, or talk about it publicly.

Image: Day 59, Project 365 - 12.18.09, a Creative Commons Attribution (2.0) image from williambrawley's photostream

CIA fake vaccine program will have wide-ranging effects on health of Pakistani children

Remember how the CIA used a phony vaccination campaign in order to collect DNA samples from Osama Bin Laden's family? (If this is news to you, there are lots of places to get the backstory. Suffice to say, it's morally grotesque. A doctor working with the CIA went around the region near the Bin Laden compound and gave inadequate doses of the vaccine, leaving behind kids whose parents thought they were protected from Hepatitis B, but who were, in fact, not.) This month, Taliban military leaders banned a U.S.-funded polio vaccination campaign from operating in the regions of Pakistan that they control. Polio is endemic in Pakistan. (Via Emily Willingham)

TOM THE DANCING BUG: Harvey Richards, Lawyer for Children

Last one to follow RUBEN BOLLING on TWITTER is a rotten egg. No except-me’s. No bounce-backs. No opposites. Starting now. For full rules, visit the TOM THE DANCING BUG WEBSITE.

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The problems with the Gates Foundation malaria vaccine

Don't get too excited about the RTS,S malaria vaccine, the development of which is being funded by the Gates Foundation. At present, the vaccine doesn't seem to work well enough to make a difference and nobody knows what it's going to cost (a big deal when you're talking about a disease like malaria, which goes hand-in-hand with poverty). Beyond that, several leading vaccine researchers are questioning the methodology used to analyze the results of RTS,S trials. The vaccine may be even less effective than previously thought. Bottom line: The research is valuable, but this particular vaccine probably won't be the breakthrough people are hoping for.