pertussis vaccine: does it prevent transmission?

[newmum35]

I've seen countless times on this site how the pertussis vaccine does NOT prevent transmission. Still it is common for articles to say the opposite, as in the one below I just read today.

In fact I was just at my (mainstream) pediatrician this week for a check up for my son (2 1/2) who has not yet had his "booster" for DTaP (this is in reference to the 4th shot... he did have the first 3 on schedule) and while talking about it (I mentioned I may give him one booster at age 4, I do not agree with both on the schedule) she asked me if I was up to date, because if not, I could "spread" it to him. (I havent been vaxed since before kindergarten over 33 years ago and have no plans to get any again.)

So my question is, what sources exactly are you using to conclude that the vaccine does NOT prevent transmission? Both sides cannot be right and I'm starting to 2nd guess myself here. The DTaP series is the only one my son has had, and I am still not entirely sure whether he will remain vaccine free from here on out or possibly receive this booster (if so, I'd like it to be age 4-5) At his age, I am no longer concerned with his ability to fight off pertussis, he is a strong healthy child still breastfed... but the booster would be for the T part (to prevent the possibility of receivng the mercury containing Tig shot in even of future ER visit) - probably not a super reason to vaccinate, but I am so highly against knowingly injecting mercury into a child (anyone for that matter), I am considering this option to avoid this possible scenerio (anyone have any thoughts on that as well?)

Any comments or helpful advice? I'd love to delve a little deeper into any sources anyone has on vaccine effectiveness and prevention of transmission of pertussis.

But while Callie was too young to receive the vaccine, family members and those around Callie should have been immunized. Transmission by adults who are not vaccinated themselves or who have not received the recommended booster shot is responsible for most pertussis cases among babies. In fact, half of babies with pertussis are infected by their parents.

http://abcnews.go.com/GMA/OnCall/bab...ry?id=10492381

[Deborah]

I have a good source but can't link directly, so I'll pull a couple of pieces.

http://www.ima.org.il/imaj/ar06may-2.pdf

Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population [19].

http://www.cdc.gov/ncidod/eid/vol6no5/pdf/srugo.pdf

The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.

[Turquesa]

Thanks, Deborah. I'm curious to see more posts on this. The idea that it does NOT prevent transmission would make sense in light of the simple fact that despite years of mass vaccination, nobody has been able to get pertussis under complete control.

[Sileree]

Some threads from the archives:

http://www.mothering.com/discussions...d.php?t=998940

http://www.mothering.com/discussions...d.php?t=900456

http://www.mothering.com/discussions...d.php?t=806782

[japonica]

Here's another one...

http://chestjournal.chestpubs.org/co...15/5/1254.full

Although the vaccine has been very effective in controlling the disease, the transmission of B pertussis has not been eliminated by vaccination and still causes morbidity, even in the vaccinated population.

[Deborah]

Pretty shocking that the drug companies have been pushing this vaccine on parents and grandparents and teenagers to protect babies from pertussis.

[japonica]

Yeah, that's always the irony and what struck me about the first link that you posted...

It states that the vaccine does not prevent spread of the bacteria, it reiterates that waning vaccine-induced immunity is a problem (compared to say, natural immunity)...other studies (like the Israeli one) demonstrate vaccine failure rates and infection and transmission of the bacteria in recently fully vaccinated individuals.

Yet, the solution?

The ideal strategy for pertussis vaccination includes universal
vaccinations against pertussis at regular intervals throughout life.

http://www.ima.org.il/imaj/ar06may-2.pdf

Hmm...it's not working that well, but let's keep doing it, doing it more often, and maybe we'll see different results. What's that quote about the definition of insanity?

[emma1325]

a question

Originally Posted by japonica

Yeah, that's always the irony and what struck me about the first link that you posted...

It states that the vaccine does not prevent spread of the bacteria, it reiterates that waning vaccine-induced immunity is a problem (compared to say, natural immunity)...other studies (like the Israeli one) demonstrate vaccine failure rates and infection and transmission of the bacteria in recently fully vaccinated individuals.

Yet, the solution?



http://www.ima.org.il/imaj/ar06may-2.pdf

Hmm...it's not working that well, but let's keep doing it, doing it more often, and maybe we'll see different results. What's that quote about the definition of insanity?

So, does that mean that those who are vaccinated with Dtap and then contract whooping cough do NOT produce the same kind of immunity to the disease than if they were left to catch whooping cough without the vaccine?
I hope that made sense.

[newmum35]

Originally Posted by emma1325

So, does that mean that those who are vaccinated with Dtap and then contract whooping cough do NOT produce the same kind of immunity to the disease than if they were left to catch whooping cough without the vaccine?
I hope that made sense.

I know. I'm trying to make sense of all this,

That can't be right.


Also on this link someone provided,
http://www.ima.org.il/imaj/ar06may-2.pdf

it says how pre-vaccine the mortality was greatest in children under 5. And I thought it was only those very young (under 6 months) babies that were at greatest risk, and thought my 2 1/2 yr old should be ok if he does get a full blown case (assuming his immunity from first 3 shots wore off, because he has not received any boosters) .. getting confused. Yet on another part it said children under 10 are by far the most affected group.

A different question here: would breastfeeding protect infant or toddler from a full blown case, assuming the mother has had some sort of exposure to pertussis in the past? I can't really ever remember having a lingering cough before. I would have had the DTP as an infant (early 70s) but havent been vaxed since before kindergarten (Im guessing I had the booster as well). So I'll be 40 in a few years, I imagine any benefit from having been vaxed wore off long ago, and at some point I was exposed to pertussis. Not sure when that might have been, but since it is so common, I assume I have at many points throughout my life and have natural immunity similar to someone who is unvaxed, correct? (since its been 33+ years since last vax) Just curious about if my toddler comes into contact with pertussis, and his immunity has faded (from the series of 3 DTaP he had) , or, if he had been unvaccinated for example, whether breastfeeding would help him avoid a case of pertussis, or at the very least, make it less severe. One would think that yes it would, but has anyone researched this, and if so what does the research show? any links on this?

[japonica]

Emma...your question made perfect sense to me. Okay, I hope that someone has some info and studies to post...the only thing that springs to mind immediately that may be relevant is Dr. James Cherry's original (antigenic) sin theory that Hilary Butler discussed in her second book (Butler 2008:471-474). Now, I'll explain it as best I can, based on my understanding of it...apparently, there's a substance called adenylate cyclase toxin (ACT), which is created by the pertussis bacteria and facilitates colonization and infection. It works to prevent the mucosal immune system (phagocytes etc.) from recognizing the bacteria initially. Pre-vaccine era, if a child was infected naturally, the body responded appropriately and once the child was exposed to the bacteria (and ACT) again, the bacteria was recognized, cleared and immunity was boosted. But apparently, the some studies have found that the vaccines do not work to increase bactericidal activity. "We found no evidence that acellular vaccines promoted antibody-dependent killing by complement, or enhanced phagocytosis by neutrophils."(1) Dr. James Cherry notes:

"Primary infections with either B.pertussis or Bordetella parapertussis stimulated a vigorous antibody response to ACT. In contrast, in patients in whom DTP and DTaP vaccines failed had minimal ACT antibody responses...Of particular interest is the lack of a significant ACT antibody response in children for whom the DTP or DTaP vaccines failed. This induced tolerance is intriguing and may be due to the phenomenon called 'original sin.'" (2)

So, apparently what happens is the child responds to all the epitopes (antigen parts) of the original infecting agent or vaccine. When older and reinfected, the child responds preferentially to the epitopes of the original infection (vaccine or natural) and has less noticeable responses to new antigens. So, according to Cherry, "Because both vaccines contained multiple antigens (i.e. PT, FHA, PRN, and fimbriae), the patients who had been vaccinated responded to antigens that they had been primed with and did not respond to the new antigen (i.e. ACT) associated with infection."(3)

Therefore, it seems like people who have whooping cough naturally develop this ability of their immune system to recognize ACT and clear the bacteria more effectively than for the people whose vaccine-created immunity did not allow them to do this.

Now, personally, I don't know if this explains everything about vaccine failure or why fully vaccinated individuals are carrying and transmitting pertussis bacteria, but it's one possible theory. I do think that the body responds differently when vaccinated compared to a natural infection (like why one immunity is short-lived while the other is generally long lasting). I also think there's something to be said for mucosal immunity, which pertussis vaccines cannot create.

Anyway, that's one theory...

(1)Weingart, C.L. et al. 2000. "Characterization of bacterial immune responses following vaccination with acellular pertussis vaccines in adults." Infect Immun, 68(12):7175-9, December.
(2)Cherry, J.D. et al. 2004. "Determination of serum antibody to Bordetella pertussis adenylate cyclase toxin in vaccinated and unvaccinated children and in children and adults with pertussis." Clin Infect Dis, 38(4):502-7, February 15.
(3)ibid

[japonica]

Originally Posted by newmum35

I know. I'm trying to make sense of all this,

That can't be right.


Also on this link someone provided,
http://www.ima.org.il/imaj/ar06may-2.pdf

it says how pre-vaccine the mortality was greatest in children under 5. And I thought it was only those very young (under 6 months) babies that were at greatest risk, and thought my 2 1/2 yr old should be ok if he does get a full blown case (assuming his immunity from first 3 shots wore off, because he has not received any boosters) .. getting confused. Yet on another part it said children under 10 are by far the most affected group.

A different question here: would breastfeeding protect infant or toddler from a full blown case, assuming the mother has had some sort of exposure to pertussis in the past? I can't really ever remember having a lingering cough before. I would have had the DTP as an infant (early 70s) but havent been vaxed since before kindergarten (Im guessing I had the booster as well). So I'll be 40 in a few years, I imagine any benefit from having been vaxed wore off long ago, and at some point I was exposed to pertussis. Not sure when that might have been, but since it is so common, I assume I have at many points throughout my life and have natural immunity similar to someone who is unvaxed, correct? (since its been 33+ years since last vax) Just curious about if my toddler comes into contact with pertussis, and his immunity has faded (from the series of 3 DTaP he had) , or, if he had been unvaccinated for example, whether breastfeeding would help him avoid a case of pertussis, or at the very least, make it less severe. One would think that yes it would, but has anyone researched this, and if so what does the research show? any links on this?

I have to get the kids ready for bed, so just quickly...I think the most affected group would be school aged children for whom vaccine-induced immunity has waned, but the group at highest risk mortality-wise would be children under 6 months old. I know when my 23 month old had pertussis, I looked up mortality and hospitalization stats just to see if any kids around age 2 had died and there were no deaths in his age group, but there were deaths reported with children under the age of 1 year. So, while older children might carry the burden of disease with the higher number of cases, I think the serious morbidity/mortality is infants. I could be wrong, but that's just my recall and interpretation of some of the studies off the top of my head.

As for the other question, this link http://www.ima.org.il/imaj/ar06may-2.pdf noted:

Transmitting low antibody levels from mothers to neonates. We rely onherd immunity and passive immunity to protect young infants before they can be protected directly by vaccination [26]. Diminishing maternal immunity increases the risk of infection among the youngest age groups, who have not yet received at least two doses of the vaccine [5].

I guess that can be taken that babies are not receiving passive immunity from their mothers, whether that's meant to be booster shots or natural immunity...I know with measles, immunity can be acquired passively by newborns whose mothers were infected with wild measles, so I'd imagine that may be possible for pertussis too...but as with measles, I don't think that extends to the vaccination-induced immunity. Anecdotally, I think you may be on to something. I know my son's case of pertussis was fairly mild (well, once we hit the right dose of SA) and he was breastfeeding the whole time too. I had full blown pertussis in my teens (I was vaxed for it too, but last booster was in elementary school). And I got a nice boost from him recently when I started coughing again, but my cough only lasted about 4 days and it was done. I'd be curious to see if anyone else has looked into breastfeeding and pertussis immunity.

[Deborah]

My family has been mostly doing without vaccines since the 1920s, although different branches are more or less consistent on this: some vaccinate fully, some delay, some don't vax at all. I'm from the "don't vax at all" block.

So I grew up with 5 children who had no vaccines whatsoever (disclaimer, a doctor gave me a tetanus shot when I was 8, without my parent's consent). As far as I can remember, none of us ever got whooping cough. Since it is an endemic disease, this means that we all had it but presented without significant symptoms.

My daughter didn't have any vaccines as a baby and I'm sure she never had a recognizable case of whooping cough. Ditto for my grandchildren, who did get DT only, considerably delayed.

So that is three generations without vaccines and without visible whooping cough.

Maybe we have a hereditary resistance?

Or maybe there is something to that original antigenic sin thing.

[an_domhan]

Originally Posted by Sileree

Some threads from the archives:

http://www.mothering.com/discussions...d.php?t=998940

http://www.mothering.com/discussions...d.php?t=900456

http://www.mothering.com/discussions...d.php?t=806782

Those are great threads. Lots of good nuggets in there.

[newmum35]

Originally Posted by Deborah

My family has been mostly doing without vaccines since the 1920s, although different branches are more or less consistent on this: some vaccinate fully, some delay, some don't vax at all. I'm from the "don't vax at all" block.

So I grew up with 5 children who had no vaccines whatsoever (disclaimer, a doctor gave me a tetanus shot when I was 8, without my parent's consent). As far as I can remember, none of us ever got whooping cough. Since it is an endemic disease, this means that we all had it but presented without significant symptoms.

My daughter didn't have any vaccines as a baby and I'm sure she never had a recognizable case of whooping cough. Ditto for my grandchildren, who did get DT only, considerably delayed.

So that is three generations without vaccines and without visible whooping cough.

Maybe we have a hereditary resistance?

Or maybe there is something to that original antigenic sin thing.

Now thats very interesting. I know for some other diseases (polio, mumps and rubella for example) a large % of people have asymptomatic infections. any stats on pertussis? either very mild symptoms no worse than a regular cold/cough or asymptomatic? possible? any stats or links on this? Because I cant imagine that my original vaccines when as a baby or a toddler are lasting me this long. I also can't imagine i never came into contact with it. And since I dont ever remember a cough for more than maybe a few days or week, Im guessing one of those times might have been pertussis and I never knew it?

[Deborah]

Someone (mamakay?) came up with a medical journal quote that 10% of unvaccinated cases are totally asymptomatic. Unfortunately, I didn't save the link.

I don't know how many cases of people who had been vaxed would be asymptomatic, especially after many years. If the original antigenic sin theory is correct, the illness would always be more trouble in the vaccinated, except for the very first time. Or something like that. I'm no expert on this!

[japonica]

Originally Posted by newmum35

Now thats very interesting. I know for some other diseases (polio, mumps and rubella for example) a large % of people have asymptomatic infections. any stats on pertussis? either very mild symptoms no worse than a regular cold/cough or asymptomatic? possible? any stats or links on this? Because I cant imagine that my original vaccines when as a baby or a toddler are lasting me this long. I also can't imagine i never came into contact with it. And since I dont ever remember a cough for more than maybe a few days or week, Im guessing one of those times might have been pertussis and I never knew it?

The only other guess I have is that maybe you did have it...perhaps the first time, it was "bronchitis" or some other label and the second time, it might have been so mild that it was just a dry hacking cough. In my husband's case, it was just a prolonged cough--slightly paroxysmal sounding at night but didn't ring any bells for us until my 23 month old got it and started whooping. After they'd both had it, I came down with a mild, hacking cough that lasted just a few days. I think that my body cleared it just fine and I had some residual immunity from my teens (when I had a nasty case of it at that point).

At the time when I had it in my teens (8 weeks of coughing, paroxysmal coughing, abx had no effect), my GP diagnosed it as bronchitis because he refused to believe anyone who was vaccinated for pertussis could be infected with it. So, perhaps something similar happened to you. Vaccine-derived "immunity" (as touted by doctors) is supposed to only last about 8-9 years, if that. And pertussis is endemic, so you would have run into people with it everywhere.

[Deborah]

There really is no such thing as vaccine "immunity" to this illness. The most you get is some sort of resistance to the symptoms, but the bacteria has access to your bod.

We can contrast this with some other vaccines for bacterial illnesses: Hib for example. The vaccine actually makes it so people cannot carry this bacteria. Which is good.

The problem, of course, is serotype replacement.

I guess the nice thing with the pertussis vaccine is that we don't get serotype replacement. I guess there are always positives to be found.

[caned & able]

Ever know a young person with chronic bronchitis? That is the standby diagnosis for pertussis for doctors who are presented with a person who is fully vaccinated, but who has a chronic cough.

Full blown pertussis is hard to miss once you hear the familiar "whoop" during a coughing attack.

[japonica]

Originally Posted by Deborah

There really is no such thing as vaccine "immunity" to this illness. The most you get is some sort of resistance to the symptoms, but the bacteria has access to your bod.

We can contrast this with some other vaccines for bacterial illnesses: Hib for example. The vaccine actually makes it so people cannot carry this bacteria. Which is good.

The problem, of course, is serotype replacement.

I guess the nice thing with the pertussis vaccine is that we don't get serotype replacement. I guess there are always positives to be found.

I was using immunity tongue-in-cheek in the way the mainstream sees it, as in vaccinated supposedly equals "immune" for a certain period of time (until boosters are required). I should have put the word in quotation marks to begin with. The material cited above provides a decent amount of evidence against true immunity coming from the vaccine.

There was something I read a while back, and correct me if I'm wrong Deborah, but it was something about the pertussis bacteria evolving away from the "type" used as the basis of the vaccine. I'll see if I can find it. I don't think it's serotype replacement obviously, but it was being tossed around as another reason as to why the vaccine has such a notable failure rate (besides the reasons we've already outlined above).

[japonica]

It was this one I was thinking of, although I'm sure I also read it elsewhere...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1626510/

Evidence of an antigenic shift of virulence factors...in circulating isolates of Bordetella pertussis has been reported... Although selective pressures created by vaccination are thought to be responsible for the observed shift of these bacterial components, no study to our knowledge has specifically identified a correlation between antigenic divergence and an increased incidence of pertussis. If future research provides evidence to support an association between higher incidence rates and antigenic divergence, then the use of both whole-cell and acellular vaccines may better protect children against a greater variety of B. pertussis strains that may be circulating in a population.