pertussis sources

[LiLStar]

I feel like I have a good understanding of pertussis, but would like an "official" source to refer people to, because it seems to be a very misunderstood disease/vaccine! Is there a good source (as in, the general vaccinating public will trust it) that explains that the vaccine does not prevent pertussis infection, but only provides immunity to the toxin produced by the bacteria, and its that toxin that causes the coughing, etc? Basically summing up that the vaccine doesn't prevent anyone from being a carrier, only prevents the clinical symptoms? I know I can find some links stating that its "unsure whether the vaccine prevents transmission" (my opinion/guess is less coughing=less transmitting, but not thinkign you're sick also means more kissing babies and sharing drinks with your friends) but I'd really like to find something that states WHY. I'm planning on writing up a facebook note in a way that doesn't come off as against the vaccine, but simply explains how it works and why the non-vaccinated are NOT the reason for pertussis "outbreaks" and I'd really like to include some good references. I want to make sure whatever I state is 100% fact, and if I include any speculation (as I did above) it'll be clearly marked as "my opinion"! 

[emmy526]

http://www.sciencedaily.com/news/health_medicine/vaccines/

just type in the word pertussis and all kinds of info will come up

all these links will give you info on that site about pertussis as well

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[slmommy]

Check out this thread:

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

I am really interested in the sources Sileree cites in post #5 and #8, etc. but it looks like some are taken from outside of the free abstracts or the links are not exactly direct. Should still be able to track down her quoted info, but I haven't gotten around to that yet. 

There are also links to other old threads which may have additional links.

[LiLStar]

Thanks, I've seen that thread but I'm giving it another look for the sources. And now I'm realizing, I simply can't find any sources that state that pertussis IS a toxoid vaccine. Is it not? I'm see that the tetanus and diptheria are toxoid, but not the pertussis part.

[emmy526]

http://www.gaia-health.com/articles451/000485-pertussis-more-virulent.shtml

[shiningpearl]

well, even though the CDC pink book is pushing vaccines, the chapter on Pertussis does talk about what causes the infection, how vaccinated may be carriers, and what causes the cough 

http://www.cdc.gov/vaccines/pubs/pinkbook/pert.html

Quote:

B. pertussis is a small, aerobic gram-negative rod. It is fastidious and requires special media for isolation (see Laboratory Diagnosis). B. pertussis produces multiple antigenic and biologically active products, including pertussis toxin, filamentous hemagglutinin, agglutinogens, adenylate cyclase, pertactin, and tracheal cytotoxin. These products are responsible for the clinical features of pertussis disease, and an immune response to one or more produces immunity following infection. Immunity following B. pertussis infection does not appear to be permanent.

[slmommy]

Originally Posted by LiLStar 

Thanks, I've seen that thread but I'm giving it another look for the sources. And now I'm realizing, I simply can't find any sources that state that pertussis IS a toxoid vaccine. Is it not? I'm see that the tetanus and diptheria are toxoid, but not the pertussis part.

I am also confused about this. I have not found it well stated anywhere. 

Dapatcel insert http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM103037.pdf

 

Quote:

The acellular pertussis vaccine components are produced from Bordetella pertussis cultures grown in Stainer-Scholte medium (2) modified by the addition of casamino acids and dimethyl-beta-cyclodextrin. PT, FHA and PRN are isolated separately from the supernatant culture medium. The FIM components are extracted and co-purified from the bacterial cells. The pertussis antigens are purified by sequential filtration, salt-precipitation, ultrafiltration and chromatography. PT is detoxified with glutaraldehyde. FHA is treated with formaldehyde, and the residual aldehydes are removed by ultrafiltration. The individual antigens are adsorbed separately onto aluminum phosphate. 

pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (PRN), and fimbriae (FIM 2/3) are antigens?

Not sure how this varies through other brands...

ETA: took out something that was not relevant to DTaP

Edited by slmommy - 3/18/12 at 3:45pm

[emmy526]

http://www.cdc.gov/mmwr/preview/mmwrhtml/00048610.htm

[slmommy]

From Emmy's link:

Quote:

The efficacy of three doses of acellular pertussis vaccines in preventing moderate to severe pertussis disease was within the range expected for most whole-cell DTP vaccines. Point estimates of efficacy ranged from 59% to 89%

Quote:

Acellular pertussis vaccines contain inactivated pertussis toxin (PT) and may contain one or more other bacterial components (e.g., filamentous hemagglutinin {FHA}, a 69-kilodalton outer-membrane protein -- pertactin {Pn}, and fimbriae {Fim} types 2 and 3). PT is detoxified either by treatment with a chemical (e.g., hydrogen peroxide, formalin and/or glutaraldehyde) or by using molecular genetic techniques. Acellular pertussis vaccines contain substantially less endotoxin than whole-cell pertussis vaccines.

.......

I didn't see anything in the link about transmission though... but I skimmed quickly for now.

Why am I seeing lots of sources referring to Diptheria and Tetanus vax are toxoid vaccines but not Pertussis? Is it because it didn't use to be - when it was old DTP with whole cell pertussis? Or do "they" not want us to easily put 2 and 2 together than a toxoid vax wouldn't always prevent transmission? I am concerned about this because following the logic I have read around here... if you have pertussis but have had the vax, you won't really realize it and can potentially spread it around. So it would seem the "cocooning" policy of vaxing everyone around newborns would potentially create a lot of problems. If someone *knew* they had pertussis, hopefully they wouldn't go anywhere, especially around babies. But I guess it is just easier to blame all non-vaxers... and not VAXERS for spreading vpd........ 

[monkeyscience]

According to The Vaccine Book by Dr. Robert Sears, the pertussis vaccine is NOT a toxoid-only vaccine. It does include some of the toxin produced by pertussis bacteria, but it ALSO includes proteins from the bacteria itself, which would provoke an immune response to the actual bacteria. It also definitely gives them impression that, when the vaccine is still effective (it doesn't always work to begin with and has often worn off in teens/adults), it DOES prevent pertussis infection/transmission. I would be interested to see a source that says that it doesn't actually prevent the disease (when working properly), because that really doesn't seem to make any sense. Mutated strains not covered by the vaccine obviously being a different story, as I believe someone upthread linked to.

[slmommy]

Ok that makes sense Monkeyscience... 

...but if the efficacy estimates are 60-90% for moderate - severe infections (no estimate for MILD infections!!!), that does leave some room for transmission, since infection is not being prevented in who knows how big a group of people.

Edited by slmommy - 3/18/12 at 4:53pm

[Bokonon]

Originally Posted by monkeyscience 

According to The Vaccine Book by Dr. Robert Sears, the pertussis vaccine is NOT a toxoid-only vaccine. It does include some of the toxin produced by pertussis bacteria, but it ALSO includes proteins from the bacteria itself, which would provoke an immune response to the actual bacteria. It also definitely gives them impression that, when the vaccine is still effective (it doesn't always work to begin with and has often worn off in teens/adults), it DOES prevent pertussis infection/transmission. I would be interested to see a source that says that it doesn't actually prevent the disease (when working properly), because that really doesn't seem to make any sense. Mutated strains not covered by the vaccine obviously being a different story, as I believe someone upthread linked to.

A study in Israel indicated that it does not prevent transmission:

http://insidevaccines.com/wordpress/vaccine-efficacy-how-often-do-vaccines-work/dtap/

I had also read that in one product insert, but can't recall which one - it said "It is unknown if this vaccine prevents transmission" or something similar.

[slmommy]

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM101580.pdf

http://us.gsk.com/products/assets/us_infanrix.pdf

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM103037.pdf

Bokonon, I did a quick search in those inserts for DTaP and two had no mention of transmission... but one did have this: (not sure if these are all the DTaP vax in US or there are more/others abroad)

Quote:

The incidence of pertussis among children aged 6 months to 4 years has remained stable throughout the 1990s, suggesting that protection offered by vaccination has continued with the introduction of DTaP vaccines.1 4 , 1 6  

Conversely, an increase in pertussis among infants too young to receive 3 doses of pertussis-containing vaccine suggests a true increase in pertussis circulation.1 4  

Atypical infection, including nonspecific symptoms of bronchitis or upper respiratory tract infection, may occur at any age but more commonly in older children and adults, including some who were previously immunized. In these cases, pertussis may not be diagnosed because classic signs, particularly the inspiratory whoop, may be absent.1 7  

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM101580.pdf

ETA: I am interested in this "true increase in pertussis circulation" they mentioned... I mean we have been vaxing for pertussis for how many decades now? What would cause a true increase in circulation? Is it because we are using DTaP instead of DTP?

[Bokonon]

Originally Posted by slmommy 

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM101580.pdf

http://us.gsk.com/products/assets/us_infanrix.pdf

http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM103037.pdf

Bokonon, I did a quick search in those inserts for DTaP and two had no mention of transmission... but one did have this:

Hmmm, maybe it was the Tdap that's been pushed so heavily lately?

[slmommy]

Here is a direct link to the Israeli study Bokonon mentioned, OP, I think this is what you are looking for.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627963/pdf/10998384.pdf

[Turquesa]

Just a couple more resources, mostly unrelated to the toxoid issue:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631860/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640897/

http://iai.asm.org/content/67/6/3133.short

http://cel.webofknowledge.com/InboundService.do?SID=2F3fN8133oJ7g1kpna5&product=CEL&UT=000274599000004&SrcApp=CR&Init=Yes&action=retrieve&customersID=Highwire&Func=Frame&SrcAuth=Highwire&IsProductCode=Yes&mode=FullRecord

Fritz Mooi, a Dutch scientist, and his team of researchers have known since the 1990s that the pertussis vaccine in circulation is addressing the wrong strain of pertussis.  But Mooi is often heralded as the Copernicus of the world of vaccine dogmatists... 

[monkeyscience]

The Israeli study is interesting, and I haven't seen it before. I guess the question still remains for me whether vaccination in these children only made their infection asymptomatic, and that is all it ever would have done, or if it made it asymptomatic as opposed to totally preventing it because the vaccines were already starting to wear off. That may not matter much in terms of a person's vaccine decision, but it certainly piques my interest as a scientist!

It does seem like several of the links make a lot more mention of the fact that pertussis vaccination is known to have a relatively low efficacy rate, not that its only effect is to lessen symptoms. I think the efficacy rates are frequently based on antibody titers in the blood, not infections detected, so I'm not sure the overall low efficacy is in indication that the disease is simply subclinical.

Either way, the relatively low efficacy rate and the very low infection rate in breastfed, non-daycare-attending newborns will probably dissuade me from giving this vaccine to my baby, especially since I consider the DT part thoroughly unnecessary for a newborn.

[emmy526]

http://cid.oxfordjournals.org/content/early/2012/03/13/cid.cis287.short

 

Quote:

Unexpectedly Limited Durability of Immunity Following Acellular Pertussis Vaccination in Pre-Adolescents in a North American Outbreak