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.
Read the rest
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."
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.