the doctor's hilarious comments... - Page 3

[Iucounu]

Boosters for young adults in France in 1998 and 2004 possibly caused a shift in the mean age of pertussis sufferers infecting infants:
http://www.landesbioscience.com/jour...aunayHV5-5.pdf

[Iucounu]

Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children:
http://pediatrics.aappublications.or...ull/123/6/1446

[Iucounu]

Delayed vaccination in New Zealand, where vaccination schedule begins at 6 weeks, associated with increased risk of pertussis:
http://www.ncbi.nlm.nih.gov/pmc/arti...71/pdf/852.pdf

[Iucounu]

http://www.ncbi.nlm.nih.gov/pmc/arti...ne.0006284.pdf
An interesting analysis (to the eyes of this layperson), showing the projected economic (and indirectly the effective) impact of different vaccination strategies. If vaccine efficacy is low, according to the study-- which could happen in the case of increasing infection by the more virulent third-serotype strain of pertussis, I guess-- routine ten-year vaccinations are shown to be the most advantageous strategy; otherwise, cocoon vaccinations (i.e. vaccinations of parents of infants) plus a booster for the general population at forty years is claimed to be better. Lots of links to good-looking info.

[Iucounu]

After reading everything I could find publicly available, some things became apparent to me:

* Parents of infants should vaccinate themselves (the "cocoon" strategy), especially if they were previously vaccinated.

* We are on the cusp of a major outbreak, due to the cultivation of the relatively new virulent third type of pertussis, encouraged by previous imperfect vaccination strategies.

* I believe the figures that quote up to 700,000 to 8,000,000 cases of low-grade pertussis per year in the US. Many studies noted that persistent coughs were often proven to be pertussis, but due to lingering immunity, were never severe enough to be diagnosed as such.

* The failure to diagnose and treat whooping cough in older people is the most likely cause for the recent increases in pertussis.

* The vaccines can actually prevent transmission, since they can prevent coughing and that is by far the most likely way for pertussis to be transmitted.

[Sileree]

You might be interested in this:

http://www.cidd.psu.edu/research/syn...inated-hosts-1

The original journal article is linked on the right side of the page.

and

http://www.ncbi.nlm.nih.gov/pubmed/11083851

BTW, according to the CDC pertussis is most contagious during the early stages when the symptoms resemble a cold and before coughing spells begin.

That being said, I do agree that transmission is probably prevented somewhat by reducing the degree and number of coughing fits (which is what DTaP is designed to do). But not enough to eliminate the disease entirely like other vaccines could if we vaccinated enough people.

[ema-adama]

Originally Posted by Iucounu

Okay, here's an article that I'm posting just because it seems to give a pretty decent overview of the two-years-ago knowledge about pertussis epidemiology:
http://www.ncbi.nlm.nih.gov/pmc/arti...6/?tool=pubmed

If everything in this article is accurate, it would indicate that vaccinations of adults could work to prevent transmission to infants, because the article claims that prolonged coughing patterns in adults go undiagnosed, resulting in unchecked transmission. It is of course just an article.

From what I have understood in this article they have identified adults and adolescents as being reservoirs for pertussis. Based on this data, they recommend the vaccine for these age groups.

Reducing the incidence of disease in the vaccinated population is not a clear measure of the success of the vaccine at interrupting circulation. Reducing the incidence in disease among the unvaccinated (like those too young to be vaccinated) is a better indication for interrupted circulation.

As Fyrestorm also pointed out, you are at your most contagious when you just have a cold. While still contagious in the initial coughing stages, you have already had 7-14 days to infect others before you knew that your cold was whooping cough.

Cocooning is not a strategy based on anything other than the knowledge that adults are reservoirs. With no good evidence that the DTaP prevents transmission, it looks like a case of trying the best with the poor tools that we have. I think inherent in this approach is "we hope it works, it might not, but at least it won't make things worse".

Some parents will choose to comply while others will not. I cannot understand a situation where this strategy is pushed with so little evidence that it actually works. However, as with all vaccine decisions, I do think parents should be given the choice.

It is well known that both vaccine induced and natural immunity do not last a lifetime. Which makes me wonder how it is that suddenly we have cases being diagnosed in older children and adults. I do not see pertussis as a re-emerging disease, but rather a disease that is still poorly understood.

I completely understand the motivation to protect young babies. And I hope the new vaccine will be able to succeed where the DTaP has not. If it is found to be safe, as in the bacteria does not mutate horribly once in the community.

[AislinCarys]

Originally Posted by Iucounu

Delayed vaccination in New Zealand, where vaccination schedule begins at 6 weeks, associated with increased risk of pertussis:
http://www.ncbi.nlm.nih.gov/pmc/arti...71/pdf/852.pdf

Of course there are more pertussis related hospital admissions, and probably child deaths, especially in winter, in New Zealand! There are a lot more hospital admissions for bronchiolitis and pneumonia, and I think about a ¼ more child deaths in winter than most other first world countries, if I remember right. Point is, due to terribly lousy housing (draghty, lack of proper insulation, single glazed windows, in a climate which is far from tropical), and a general attitude of “if you're cold, put on an extra jersey”, it is really common that the mildest cold turns into something severe.

In our antenatal groupmost of the babies had antibiotics during their first winter, mostly for ear infections, but there was also two cases of bronchiolitis and one of pneumonia, all of which ended up spending a week or two in hospital.

I've never actually heard of anyone with pertussis (and I live in a mayor city, and know, through my earlier work, lots and lots of families), although we did get a leaflet when DD was born (printed 6 or 7 years ago), screaming out that NZ was in the middle of a pertussis epidemic.

I doubt the first few weeks matter that much, especially as full protection isn't reached until about 6 months, and it is at most 85%, possibly as low as 64%.

[Iucounu]

Originally Posted by ema-adama

From what I have understood in this article they have identified adults and adolescents as being reservoirs for pertussis. Based on this data, they recommend the vaccine for these age groups.

Reducing the incidence of disease in the vaccinated population is not a clear measure of the success of the vaccine at interrupting circulation. Reducing the incidence in disease among the unvaccinated (like those too young to be vaccinated) is a better indication for interrupted circulation.

Right, there is no clear measure at present. All I meant was that since whooping cough is spread by coughs and sneezes, if those are even diminished, the vaccine will quite obviously prevent some transmissions. So it's can't completely ineffective at preventing transmission; and the reason it sometimes is claimed to be, is most likely the vast reservoir of infected older people that currently pose a much larger risk of infection than the (properly) vaccinated.

I think cocooning is based on the idea that the vaccines reduce coughing and sneezing, and it seems to me that based on the fact that the vaccines do reduce these things, and are shown to be fairly effective in reducing infection, it makes a lot of sense for parents to get immunized. The lower birth weights and longer hospital stays of the preemies in that one study are troubling to say the least, though. And of course, what makes the most sense is for more and better studies to be done.

[ema-adama]

Yeah, my understanding is that cocooning is advocated on the premise that it reduces the spread of the bacteria while coughing (I have not read about the vaccine reducing sneezing - it works on the toxin that creates the whoop in the cough and lessens the severity of the cough).

However, I am pretty sure that parents who are offered the vaccine are not told that no one knows if this will work or not. They are more likely to be told that it will protect their baby and it is irresponsible not to do it.

Pretty much like some people say that the current outbreak of pertussis in the US is because parents are not vaccinating. Which is not really a position that can be supported when you get into the details of it. Unvaccinated children are a really small group compared to the adolescents and adults who have waning immunity. It is not unvaccinated children that have made pertussis endemic.

ETA: What makes you think that the current circulating bacteria is a result of a poorly executed vaccination policy and not a result of a poorly designed vaccine?

[Bokonon]

Originally Posted by ema-adama

Yeah, my understanding is that cocooning is advocated on the premise that it reduces the spread of the bacteria while coughing (I have not read about the vaccine reducing sneezing - it works on the toxin that creates the whoop in the cough and lessens the severity of the cough).

However, I am pretty sure that parents who are offered the vaccine are not told that no one knows if this will work or not. They are more likely to be told that it will protect their baby and it is irresponsible not to do it.

Pretty much like some people say that the current outbreak of pertussis in the US is because parents are not vaccinating. Which is not really a position that can be supported when you get into the details of it. Unvaccinated children are a really small group compared to the adolescents and adults who have waning immunity. It is not unvaccinated children that have made pertussis endemic.

[Marnica]

Originally Posted by Iucounu

Okay, here's an article that I'm posting just because it seems to give a pretty decent overview of the two-years-ago knowledge about pertussis epidemiology:
http://www.ncbi.nlm.nih.gov/pmc/arti...6/?tool=pubmed

If everything in this article is accurate, it would indicate that vaccinations of adults could work to prevent transmission to infants, because the article claims that prolonged coughing patterns in adults go undiagnosed, resulting in unchecked transmission. It is of course just an article.

I would also add (not gleaned from this article just in general) that prolonged coughing in vaccinated children goes undiagnosed and results in unchecked transmission, thus making other children (often fully vaccinated) likely to pass on pertussis as well.

[Iucounu]

Originally Posted by ema-adama

Yeah, my understanding is that cocooning is advocated on the premise that it reduces the spread of the bacteria while coughing (I have not read about the vaccine reducing sneezing - it works on the toxin that creates the whoop in the cough and lessens the severity of the cough).

Since it actually seems to prevent infection in some people, I just assume it cures the sneezing problem. Perhaps I misunderstood what I read-- I will double-check. In any event a distinction re: cocooning may be academic; I am going to go out on a limb and guess that parents can pass bugs like pertussis to infants from more than just sneezing and coughing.

However, I am pretty sure that parents who are offered the vaccine are not told that no one knows if this will work or not. They are more likely to be told that it will protect their baby and it is irresponsible not to do it.

I think everyone everywhere ought to be told the truth, and there ought to be a better focus on finding it out just for that purpose. I'm astounded at the state of the studies on this.

Pretty much like some people say that the current outbreak of pertussis in the US is because parents are not vaccinating. Which is not really a position that can be supported when you get into the details of it. Unvaccinated children are a really small group compared to the adolescents and adults who have waning immunity. It is not unvaccinated children that have made pertussis endemic.

There is one interesting paper that I didn't link, because I didn't want to offend anyone, that claimed to show that opinion grouping (i.e. nonvaxers concentrated in one area) meant that the total overall vaccination percentage would have to be adjusted to a higher level to reasonably assure herd immunity across the board. But I agree with you; the current pertussis problem is a direct result of past vaccination history, not parents here and there deciding not to vaccinate. The vast army of one-hundred-day-coughing adult zombies is the enemy now, not a few parents.

What makes you think that the current circulating bacteria is a result of a poorly executed vaccination policy and not a result of a poorly designed vaccine?

I guess that any vaccine with waning immunity might be potentially prone to similar problems of creating superbugs, but vaccines are arguably prone to that anyway. Here, I think the vast teen-adult pertussis reservoir is due not only to waning immunity, but failure to properly communicate to those vaccinated in the past that they need boosters, among other problems. It seems obvious to me that a never-vaxed adult getting pertussis for the first time stands a much better chance of being correctly diagnosed, at least after the whooping phase starts.

[heathergirl67]

Originally Posted by ema-adama

ETA: What makes you think that the current circulating bacteria is a result of a poorly executed vaccination policy and not a result of a poorly designed vaccine?

Since naturally acquired immunity to pertussis doesn't last long, either- at least compared to other VPD's- I wonder if that's something that can't be helped. Something that is part of pertussis that makes it difficult or impossible to get longer-lasting immunity. Knowing that, like PP stated, it really is important for doctors to make sure that their patients know that they need boosters. Which would make it poorly executed vaccination policy.

[Pirogi]

Originally Posted by heathergirl67

Since naturally acquired immunity to pertussis doesn't last long, either- at least compared to other VPD's- I wonder if that's something that can't be helped. Something that is part of pertussis that makes it difficult or impossible to get longer-lasting immunity. Knowing that, like PP stated, it really is important for doctors to make sure that their patients know that they need boosters. Which would make it poorly executed vaccination policy.

You sort of proved the point that the vaccine stinks here. If the vaccine doesn't work to curb the disease, then the vaccine policy has to be more stringent. And if the vaccine policy isn't communicated to the population, it is a policy failure. But, if the vaccine worked effectively, we wouldn't need a more stringent policy to begin with. Kind of circular logic.

[heathergirl67]

Originally Posted by Pirogi

You sort of proved the point that the vaccine stinks here. If the vaccine doesn't work to curb the disease, then the vaccine policy has to be more stringent. And if the vaccine policy isn't communicated to the population, it is a policy failure. But, if the vaccine worked effectively, we wouldn't need a more stringent policy to begin with. Kind of circular logic.

By that do you mean, if the vaccine gave longer-lasting immunity? Because if that's what you mean, that's what I'm saying.... since naturally acquired immunity also doesn't last long, I wonder if it's something about pertussis that makes it difficult/impossible to do for vaccines?

[Pirogi]

Originally Posted by heathergirl67

By that do you mean, if the vaccine gave longer-lasting immunity? Because if that's what you mean, that's what I'm saying.... since naturally acquired immunity also doesn't last long, I wonder if it's something about pertussis that makes it difficult/impossible to do for vaccines?

Yes, longer lasting, and broader across the population (more people showing an immune response), and more effective at stopping transmission. All of these things "should" happen in a "good" vaccine. I suppose if we're talking about design of the pertussis vaccine, I see your point, in that can we really design a better vaccine? But really, does it matter if it's called a design failure vs some intricacy with the bacteria/disease pattern itself? The bottom line is that it doesn't work in a population very well. And THAT is what should be conveyed to people who are deciding on administering this vaccine to their children or themselves. But that isn't what the medical establishment is saying. They continue with the party line ... "It is effective. It is safe. If you don't get it, you are irresponsible. Don't ask questions."

[caned & able]

Originally Posted by PlayaMama

uh, the chances of seeing a vpd is pretty small so statistically, it would not be logical to have that as your first diagnosis. that doesn't really seem like faith, it seems like a logical conclusion.

i guess that's maybe because i have a pretty strong grounding in how science works, i'm not sure.... but comparisons between science and religion always miss some of the key elements of science.

So why was my cousin not diagnosed with measles by the younger intern? I know it is because the younger intern had never seen a case of measles and was not trained to look for it; she had a religious belief in the vaccine that it had wiped out measles. She had my cousin's records in front of her. She knew that she was not vaccinated. When my Aunt cross examined her, the intern did not know what she was talking about. She said the fever and rash were caused by the virus that my cousin had. Of course, she did not know that the rash and fever were measles ...

My point is that most doctors do not know a case of vpd even when it is staring them in the face, as this doctor.

As for a grounding in science, I have that too. I also have a grounding in logic. If it walks like a duck, ...