Dilema - newborn/older siblings/whooping cough

[frebell]

I would really appreciate some advice on a situation I am in right now.

We changed paeds this week to a very laid back Dr regarding vaccinating choices.

However, during the visit, he mentioned that my 3 year old (who was fully vaccinated till 13 months), is "due" the vaccine for pertussis, and that he would highly recommend giving it to him since there are some cases of whooping cough in our surrounding area at the moment.

He also wrote down the vaccines my 22 month old daughter is "due" (she was vaccinated until 4 months,after which I finally saw sense) but he stressed that he highly recommends the DTaP specifically (he didn't care about other 3-4 due).

Based on research I have done after hearing this from him,  I would be confident in not giving either of them the vaccine.

However, I am worried as I am pregnant with our next baby due in July. I am unsure how worried I should be of the fact that my son goes to preschool and could come into contact with whooping cough and bring it home when the new baby is only a few weeks old.

As a side note, I know that I am immune to the infection that causes whooping cough, as my midwife tested me for it just over a month ago and I intend to exclusively breastfeed the new baby (as I did/do for my 2 other children), not sure if that has any relevance to this issue? but thought I would mention it incase any of those those antibodies are perhaps passed on?

Anyway, if some knowledgeable person could explain to me, whether the risk of my son not receiving the vaccine would effect the new baby any more severely than if he does received it, in any way. I would truly appreciate it.

Thank you

[stik]

My cousin's baby was born during a whooping cough outbreak.  Mom and baby were rushed out of the hospital and told not to leave the house for 8 weeks.  It was her first, so she didn't have older kids at home to complicate things.  

Breastfeeding will help pass on immunity, but it's not 100%.  The vaccine isn't 100% either - but it does generally result in a milder case of the disease in people who catch it.  There have been multiple outbreaks of pertussis lately, and it is MOST dangerous for babies too young to be vaccinated.  Preschools have amazing educational benefits, and are also amazing vectors for transmission of diseases.  If your older ds is vaccinated, you reduce the chances that he will bring pertussis home from preschool.  If he gets pertussis anyway, it will be a milder case of the disease.  If he's not vaccinated, he is more likely to bring pertussis home, and to have a more severe case.  This increases the chances that the baby will be exposed.  Babies with pertussis can cough so hard they get hernias.  They are more vulnerable to respiratory infections. 

I'm inclined to agree with your doc that DTAP is important and you should get that one.  

[Taximom5]

I would like to see more information about whooping cough.

I can't help wondering if  the information about it now is simply...incorrect.

When my (fully vaccinated) kids got it as infants, our pediatrician was NOT concerned. Neither was I.  They whooped, it sounded awful, but, as per instructed, I put them in the steamy shower room, and then either outside or we breathed in air from the freezer, and they immediately improved.  They got over it within a day or two, and it was no big deal.

I do see that it can be a very big deal to some, even fatal in some infants.

What I would question is, what are the factors leading to susceptibility among those particular infants? Did the infants who died have underlying medical conditions? Were they breast-fed or bottle-fed? Did they have vitamin deficiencies of any kind? Is it even possible that receiving vaccines for other diseases immediately before exposure to whooping cough could undermine the immune process against whooping cough?

Did those infants have some kind of autoimmune process going on?  As Imakcerka mentioned, the number of people with autoimmune disorders has increased to the point where many feel that it's routine, almost normal.

Why is whooping cough considered more dangerous now than it was even a few decades ago? It's not because of the pertussis vaccine, because my mother and grandmothers all knew of whooping cough as an annoying but routine childhood illness that was rarely dangerous to a healthy child, and they never freaked out about infants being exposed to whooping cough.

[slmommy]

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6041a4.htm

This has some interesting info in regards to your immunity to pertussis (and addresses thoughts on "cocooning" - or vaccinating family members - although focuses on adults/teens not young siblings they assume would have received dtap round)

Quote:

For infants, transplacentally transferred maternal antibodies might provide protection against pertussis in early life and before beginning the primary DTaP series. Several studies provide evidence supporting the existence of efficient transplacental transfer of pertussis antibodies (7,11,12). Cord blood from newborn infants whose mothers received Tdap during pregnancy or before pregnancy had higher concentrations of pertussis antibodies when compared with cord blood from newborn infants of unvaccinated mothers (7,11). The half-life of transferred maternal pertussis antibodies is approximately 6 weeks (12). The effectiveness of maternal antipertussis antibodies in preventing infant pertussis is not yet known, but pertussis-specific antibodies likely confer protection and modify the severity of pertussis illness (13,14). In addition, a woman vaccinated with Tdap during pregnancy likely will be protected at time of delivery, and therefore less likely to transmit pertussis to her infant. After receipt of Tdap, boosted pertussis-specific antibody levels peak after several weeks, followed by a decline over several months (15,16). To optimize the concentration of maternal antibodies transferred to the fetus, ACIP concluded that unvaccinated pregnant women should receive Tdap, preferably in the third or late second (after 20 weeks gestation) trimester.

So, there is reason to believe, that you will pass some antibodies to your baby for the first 6 weeks of life, that would decrease chance/reduce severity of infection.

BUT, article goes on...

Quote:

Several studies have suggested that maternal pertussis antibodies can inhibit active pertussis-specific antibody production after administration of DTaP vaccine to infants of mothers vaccinated with Tdap during pregnancy, referred to as blunting (12,17). Because correlates of protection are not fully understood, the clinical importance of blunting of an infant's immune response is not clear. Evidence suggests that any blunting would be short-lived because circulating maternal antibodies decline rapidly (12,18). Circulating maternal pertussis antibodies might reduce an infant's risk for pertussis in the first few months of life but slightly increase risk for disease because of a blunted immune response after receipt of primary DTaP doses. 

but at least then the baby is slightly older...

I haven't done much of my own research into it... but here is a thread with some links

http://www.mothering.com/community/t/1238577/does-or-does-not-pertussis-vaccine-prevent-transmission

apparently some people are saying that pertussis vax does not prevent transmission because it makes you immune to the toxin produced by the bacteria, so vaccinated people can have and carry pertussis, but it is *hidden* so to speak since they are not having the tell-tale whooping coughs. I have seen people saying that this means older vaccinated individuals can have it and carry it to newborns without knowing it, whereas someone who was unvaccinated and contracted wc WOULD know, and then *hopefully* would stay away from newborns and well, everyone.

(I haven't looked into this much myself, so I am not presenting this as fact, just something to look into! If anyone else can speak to this, please do!)

[stik]

There are plenty of historical accounts of moms freaking out about whooping cough.  Whooping cough outbreaks were a major reason parents chose to have family pictures taken in the 19th century.  They thought it might be their last chance to have all their children photographed together.  Alive, anyway.  

Remember, the Victorian era was very sentimental. Families were supposed to have deep emotional bonds. Their were huge rituals surrounding grief and mourning. Moms were supposed to protect children from everything - danger, disease, immorality.  Working women were harshly criticized for not supervising their children's every move, and for letting them get sick   In the 20th century mothers were supposed to be confident in their children's strength and eschew overprotective parenting practices - bind up cuts without a fuss, tell the kid to get back on the pony.

But they were also supposed to sterilize practically everything.  
 

Originally Posted by Taximom5 

I would like to see more information about whooping cough.

I can't help wondering if  the information about it now is simply...incorrect.

When my (fully vaccinated) kids got it as infants, our pediatrician was NOT concerned. Neither was I.  They whooped, it sounded awful, but, as per instructed, I put them in the steamy shower room, and then either outside or we breathed in air from the freezer, and they immediately improved.  They got over it within a day or two, and it was no big deal.

I do see that it can be a very big deal to some, even fatal in some infants.

What I would question is, what are the factors leading to susceptibility among those particular infants? Did the infants who died have underlying medical conditions? Were they breast-fed or bottle-fed? Did they have vitamin deficiencies of any kind? Is it even possible that receiving vaccines for other diseases immediately before exposure to whooping cough could undermine the immune process against whooping cough?

Did those infants have some kind of autoimmune process going on?  As Imakcerka mentioned, the number of people with autoimmune disorders has increased to the point where many feel that it's routine, almost normal.

Why is whooping cough considered more dangerous now than it was even a few decades ago? It's not because of the pertussis vaccine, because my mother and grandmothers all knew of whooping cough as an annoying but routine childhood illness that was rarely dangerous to a healthy child, and they never freaked out about infants being exposed to whooping cough.

[prosciencemum]

Some information from the Public Health Agency of Canada which seems relevant and very clearly laid out. All from the below link.

http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-pert-coqu-eng.php

It says that

Quote:

The disease can affect individuals of any age; however, severity is greatest among young infants. One to three deaths occur each year in Canada, particularly in infants too young to have begun their immunization and in partially immunized infants (e.g., one or two doses).

It also says that:

Quote:

Serious adverse events are rare following immunization and, in most cases, data are insufficient to determine a causal association.

As with every vaccine, the protection will not be 100% so you can get pertussis after vaccination, and you can also carry it. But the chance is much lower in both cases, and you imply your son has already had vaccinations with no bad reaction which should remove most of the worry. 

[prosciencemum]

I found something help which might (or might not) help. 

http://luckylosing.com/2012/02/21/meryl-dorey-and-australias-pertussis-epidemic/

(fair disclosure, this link found via the Facebook page "Stop the Australian Vaccination Network", and the author clearly annoyed by AVN and Meryl Dorey - and definitely pro-vaccine - but they provide evidence based information about the risks from pertussis which you might find helpful in your decision). 

[GoBecGo]

Taximom5 are you sure it was whooping cough your kids had?  It sounds more like croup...?  My brother whooped with croup until he was about 23 (!), I used to wake up to him whoooping through the wall whenever he had it.  We also had whooping cough as children, but my mother said unlike croup it went on for weeks and weeks, though we had antibiotics for it (and lots of standing near the tar melter when they were resurfacing the roads which i remember!).  My friends kids had it a few years back and theirs (unvaxed and no antibiotics) lasted 3 months (they're in Germany and their homeopathic Paed refers to it as hundred days cough).

OP have you talked to you Dr about what he'd do if they WEREN'T vaxed and DID catch it?  Antibiotics do reduce the severity and transmission rates of pertussis, you might feel that's a better option for your guys?  Maybe if you can get good info on the other treatment options (what he'd prescribe, transmission rates with that option etc.) it'd help you make your choice?

[Taximom5]

Originally Posted by GoBecGo 

Taximom5 are you sure it was whooping cough your kids had?  It sounds more like croup...?  My brother whooped with croup until he was about 23 (!), I used to wake up to him

Good question.

The pediatrician diagnosed it as pertussis. It never occurred to me to challenge his diagnosis, particularly when his "Rx" worked so well, but who knows?

[GoBecGo]

Originally Posted by Taximom5 


Good question.
The pediatrician diagnosed it as pertussis. It never occurred to me to challenge his diagnosis, particularly when his "Rx" worked so well, but who knows?

It's kind of moot since he couldn't test anyway (they would have had pertussis antibodies anyway if they were vaxed).  Was the RX erythromycin?  Or a steroid like epinephrine?  If it was the former it really could have been WC, if the latter then more likely to be croup (croup is usually viral).  I only realised how similar the whoop can be when someone linked me a video of "unmistakable whooping cough" on YouTube and it was totally the same!  My brother suffered so often and for so long, apparently, because he was a premature baby who'd had a lot of lung problems/damage at birth.

[Taximom5]

The "Rx" was to steam up the bathroom with the shower on hot, take the baby in for 10 minutes (into the bathroom, not into the shower), and then to take the baby (well-bundled up) outside into the cold air for 5 minutes (it was January for two of my babies when they had this), or to open the freezer door, lean in with the baby and breathe the cold air for 5 minutes.

(Yeah, that's why I put quotes around "Rx.")

I was absolutely AMAZED at how quickly and how well it worked, not as a cure, but as a method for stopping the cough, easing the breathing, and allowing the baby (and mommy) to get some sleep for a couple of hours.  Repeated as needed, with no side effects!

We discussed pertussis but not croup.  I asked the doctor why they would get pertussis if they'd been vaccinated, and he said he felt that the vacine did not work well; perhaps the virus mutated, perhaps it was a different strain, he didn't know but he felt that the vaccine didn't work in quite a few cases.

He really didn't seem worried.  So I wasn't worried.  And that can go a long way towards helping the healing process, too.

[Bokonon]

Originally Posted by GoBecGo 

It's kind of moot since he couldn't test anyway (they would have had pertussis antibodies anyway if they were vaxed).  Was the RX erythromycin?  Or a steroid like epinephrine?  If it was the former it really could have been WC, if the latter then more likely to be croup (croup is usually viral).  I only realised how similar the whoop can be when someone linked me a video of "unmistakable whooping cough" on YouTube and it was totally the same!  My brother suffered so often and for so long, apparently, because he was a premature baby who'd had a lot of lung problems/damage at birth.

There is a nasal swab test for pertussis and parapertussis infection.

[Taximom5]

Originally Posted by Bokonon 

There is a nasal swab test for pertussis and parapertussis infection.

We weren't offered that.  This was a few years ago, before the heavily marketed news about pertussis outbreaks.  The pediatrician believed it was pertussis (which certainly doesn't mean that it was), and honestly, 5-10 years ago, nobody in our area seemed to be  worried about pertussis, even when babies got it in the day care centers.  You brought your baby home, if (s)he was at daycare, and you followed the "Rx" and your baby got better.

I assume that parents of babies with underlying medical disorders would be more anxious, due to the possibility of complications, but there could be complications from ANY virus with an underlying disorder, not just pertussis.

[GoBecGo]

Originally Posted by Taximom5 

The "Rx" was to steam up the bathroom with the shower on hot, take the baby in for 10 minutes (into the bathroom, not into the shower), and then to take the baby (well-bundled up) outside into the cold air for 5 minutes (it was January for two of my babies when they had this), or to open the freezer door, lean in with the baby and breathe the cold air for 5 minutes.

(Yeah, that's why I put quotes around "Rx.")

I was absolutely AMAZED at how quickly and how well it worked, not as a cure, but as a method for stopping the cough, easing the breathing, and allowing the baby (and mommy) to get some sleep for a couple of hours.  Repeated as needed, with no side effects!

We discussed pertussis but not croup.  I asked the doctor why they would get pertussis if they'd been vaccinated, and he said he felt that the vacine did not work well; perhaps the virus mutated, perhaps it was a different strain, he didn't know but he felt that the vaccine didn't work in quite a few cases.

He really didn't seem worried.  So I wasn't worried.  And that can go a long way towards helping the healing process, too.

That's exactly what they prescribed for croup (the whoop used to make me think "oh great, no shower for ME this morning" when we were teenagers).

[Taximom5]

Just out of curiosity, are they doing nasal swab tests NOW every time they diagnose a pertussis/parapertussis infection?  

Is it possible that the pertussis outbreaks (that they are blaming on the unvaxed even though it's mostly vaxed who get and spread the virus) are, for at least some, misdiagnosed, and really croup?

[Bokonon]

Originally Posted by Taximom5 

Just out of curiosity, are they doing nasal swab tests NOW every time they diagnose a pertussis/parapertussis infection?  

Is it possible that the pertussis outbreaks (that they are blaming on the unvaxed even though it's mostly vaxed who get and spread the virus) are, for at least some, misdiagnosed, and really croup?

I doubt that docs are diagnosing with the swab every time.

I think many of the "outbreak" infections are bronchitis, croup, nondescript virus, etc.

My son was tested with the nasal swab - fully vaccinated but had a cough that wouldn't go away after his last DTaP.  He tested negative.  

[34me]

My son had his snot sucked out 2 weeksago after an outbreak at his school.  He is (mostly) vaxed but the majority of the kids at his school are not.  I leave it up to each family to do what is right for them.  The initial kids were from the same family and unvaxed.  No biggie I got to spend 4 full days with just my 13 yo.  And yes, all the suspected kids were tested at his school.  Some were positive (mine and others) and some were negative.  And some had chicken pox; both were going around the same time. 

So would I vax him again if I had to do it over?  Probably not, he got it anyway.  But he did seem to have pertussis "lite"

[Marnica]

Actually I think that diagnosing via swab is the exception vs the rule. Most doctors will not do a swab is a child is vaccinated and will diagnose it as something else. I think a swab is more likely to be done when a child is unvaccinated or if the vaccinated child has had a known exposure pertussis as the PP just said (like an outbreak at school). I think it's also important to remeber, the swab is only really accurate in the catarrhal or early paroxysmal stage of illness. How often are swabs done in those stages? I mean most parents who have a child whose nose is running and has only a mild cough are not demanding a nasal swab (unless there was known exposure). By the time the cough really sets in and a parent suspects pertussis, the swab will likely come back negative anyway.

 

Originally Posted by Bokonon 

I doubt that docs are diagnosing with the swab every time.

I think many of the "outbreak" infections are bronchitis, croup, nondescript virus, etc.

My son was tested with the nasal swab - fully vaccinated but had a cough that wouldn't go away after his last DTaP.  He tested negative.  

[laohaire]

I am just super impressed with how the participants on this thread have presented their thoughts, positions and references.

This was one of the more useful VPD discussions I've seen in a long time. When the discussion isn't heated and bipartisan, it's possible to take in so much more information.

[nia82]

You could also run a titer test on your older child to see if she even needs a booster.