Pertussis...It's not just WA state! 2012 numbers as of 2 days ago - Page 2

[nukuspot]

In WA we used to have one of the highest exemption rates for kids going into K (6%).  In 2011 a law passed that parents had to have a signed form from their doctor to do a philospical exemption.  that made the rates drop significantly to 4.5% (So now under the 95% stat for "herd immunity" if herd immunity was applicable to pertussis which I still maintain it is not due to the inadequacy of the aP part of DTaP.)

However this year, AFTER our big rise in vaccination rates for kids, we are now in a pertussis epidemic.  So I still don't see the correlation.

And the CDC has stated in the updated MMWR for "prevention of pertussis, diptheria, and tetanus in pregnant and postpartum women and their infants" that the vaccination compliance rates for DTaP are rising each year.  That is where i got the 99% of all children are up to date on their vaccine status info from.  So unless the CDC and WA DOH are lying, vaccination compliance rates are rising.  But so are cases of pertussis.

[Rrrrrachel]

It's about spotty coverage not the overall rate. Pertussis requires a higher than normal level of coverage for solid herd immunity.

I'm sure there are lots of things at play. I don't want to get cornered into overstating my position, but vaccine rates play their part.

[nukuspot]

Originally Posted by nukuspot 

That's awesome info, thanks.  I was looking at travel medicine clinics for my MIL last month.  Her GP called the local travel medicine clinic and was told (again) that no pertussis vaccine is approved for adults in the UK (anyone over 7) so they cannot legally give it.  It's been very frustrating because we want to try to implement cocooning (as much as possible---Yes, I know it's been debunked on here but I STILL think if is better than nothing) once the baby is born but they are having a hell of a time getting a Tdap over there.  Her GP said "Pertussis isn't an issue for adults."  UGH!!!

Oh...We BOTH have to read this better.  We are so used to reading "Diptheria, Tetanus and PERTUSSIS" over here.  What that actually says on that price list is "Diptheria, Tetanus, and POLIO."

No place on that list does it list pertussis.  Back to the drawing board.

[nukuspot]

Rachel,  Higher than 99% coverage rates the CDC mentions?  You mean if there was universal vaccination and every single child was vaccinated in this entire country it *might* show a drop in pertussis cases?  I think we can both agree that is never going to happen.

[Rrrrrachel]

The rate is not consistently that high everywhere. That's the problem. Or the part of the problem rates are contributing to. However you want to say it.

[slmommy]

Originally Posted by Rrrrrachel 

It's about spotty coverage not the overall rate. Pertussis requires a higher than normal level of coverage for solid herd immunity.
I'm sure there are lots of things at play. I don't want to get cornered into overstating my position, but vaccine rates play their part.

...and possibly play a part in mutating pertussis, but we have already cycled through this whole discussion on every.single.other recent pertussis thread on these boards.

Quote:

Consistent with this notion, pertussis has reemerged in the Netherlands, despite high vaccination coverage. Further, a notable change in the population structure of B. pertussis was observed in the Netherlands subsequent to the introduction of vaccination in the 1950s. Finally, we observed antigenic divergence between clinical isolates and vaccine strains, in particular with respect to the surface-associated proteins pertactin and pertussis toxin. Adaptation may have allowed B. pertussis to remain endemic despite widespread vaccination and may have contributed to the reemergence of pertussis in the Netherlands.

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

[nukuspot]

Yes, back to the original topic.  "Pertussis, it's not just in WA state."

[Rrrrrachel]

Yes, slmommy, that might be playing a part, too. I read an interesting article the other day that said those results might be due to drift rather than mutation. Either way I hope a more effective vaccine that accounts for it is on the way.

Pertussis sure presents a lot of challenges other vpds don't.

[Turquesa]

Originally Posted by nukuspot 

In WA we used to have one of the highest exemption rates for kids going into K (6%).  In 2011 a law passed that parents had to have a signed form from their doctor to do a philospical exemption.  that made the rates drop significantly to 4.5% (So now under the 95% stat for "herd immunity" if herd immunity was applicable to pertussis which I still maintain it is not due to the inadequacy of the aP part of DTaP.)

However this year, AFTER our big rise in vaccination rates for kids, we are now in a pertussis epidemic. 

Your post is helpful, but...........memo to Washington State government spin doctors.....

Correlation. Is. Not. Causation!

[prosciencemum]

Originally Posted by nukuspot 

Oh...We BOTH have to read this better.  We are so used to reading "Diptheria, Tetanus and PERTUSSIS" over here.  What that actually says on that price list is "Diptheria, Tetanus, and POLIO."

No place on that list does it list pertussis.  Back to the drawing board.

Oh sorry. I posted that late at night, and its usually Diptheria, Tetanus and Pertussis I thought. Sorry I got your hopes up. 

[Rrrrrachel]

This is the kind of data I'm looking at when I say Dtap rates are low all over the country.  This is from 2009, so it's not completely up to date, but for example the national average for full dtap coverage is 83.9 percent.  

http://www.immunize.nc.gov/data/immunizationrates.htm

Especially for something like pertussis where there are additional challenges like waning immunity and a lower effectiveness rate that's not high enough for herd immunity to set in.

This talks about how the rate varies from county to county, even if the overall rate is high enough for herd immunity when it's significantly lower in too many communities it causes problems.

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6004a1.htm

Basically if an outbreak can get a foothold in a community and gain enough momentum it can spread to other communities even if their vaccine rate is theoretically high enough, especially for a disease like pertussis.

I posted studies earlier that found a correlation between counties with lower vaccination rates and pertussis cases.  

[Rrrrrachel]

Here's some good data on vaccine coverage in minnesota.  Dtap has the lowest coverage of all the vaccines (another thing I pointed out earlier when the overall rate was used is that dtap tends to have a lower coverage rate because of a reputation for reactions holding over from the old whole cell vaccine).

http://www.health.state.mn.us/divs/idepc/immunize/stats/coverdata.html

Notice the disparity in various counties, just glancing down the table the dtap rate in a community might be as high as 95% or as low as 47%.  This is as of January 2011.

More worrying than the disparity in vaccine rates itself is that that disparity is largely NOT due to people like educated consumers on MDC who have made an informed choice for their child not to be vaccinated and are prepared adn equipped to deal with the possible consequences.  Lower vaccine rates are more correlated with poverty and variables like housing stress.  A child who hasn't had their full course of vaccines is more likely to have missed some due to poverty than an active choice their parents made.

[Rrrrrachel]

here's a study from 2009 talking about problems with vaccine coverage in colorado.  Note again they say that the biggest problem area is dtap.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936967/

[Rrrrrachel]

The four states mentioned in the original article are Wisconsin, Washington, New York, Illinois, and Pennsylvania.  If you look at the latest Dtap data from the CDC these states all have sub 90 rates for vaccine coverage on Dtap for children, with the exception of wisconsin which is 95.  I could not find comparable data on coverage in teens and adults, but I imagine the numbers for those groups look worse, although it is pure speculation on my part.

A study I've posted here before that was published in Pediatrics found that children who were not vaccinated for pertussis were 23 times more likely to get sick from it.  It's not clear how much of a role vaccination plays in these outbreaks compared to the other factors that have been discussed, but getting yourself and your family fully vaccinated is still one of the most important ways to protect yourselves from pertussis.

[prosciencemum]

Originally Posted by Rrrrrachel 

More worrying than the disparity in vaccine rates itself is that that disparity is largely NOT due to people like educated consumers on MDC who have made an informed choice for their child not to be vaccinated and are prepared adn equipped to deal with the possible consequences.  Lower vaccine rates are more correlated with poverty and variables like housing stress.  A child who hasn't had their full course of vaccines is more likely to have missed some due to poverty than an active choice their parents made.

That is really worrying. How do childhood vaccinations work in the US for the uninsured? I guess children in most (all?) states can get free medical care if their family can't afford it, or is that just naivety on my part? 

There are definite issues with the NHS, but I it is things like this which make me grateful for it. :) 

The WHO maintains an estimate of global vaccination coverage for a variety of countries and vaccinations here: http://www.who.int/immunization_monitoring/routine/immunization_coverage/en/index4.html

This is the table for the 3rd does of DTP country by country:

http://apps.who.int/immunization_monitoring/en/globalsummary/timeseries/tswucoveragedtp3.htm

They have the UK in 2010 at 96% and the US at 95%, and no evidence of a huge decline over the last 10 years. 

[slmommy]

Originally Posted by prosciencemum 

That is really worrying. How do childhood vaccinations work in the US for the uninsured? I guess children in most (all?) states can get free medical care if their family can't afford it, or is that just naivety on my part? 

Federally funded Vaccines For Children program (CDC) provides no cost vaccines for under/un-insured/medicaid and eligible children can receive everything ACIP recommends.

[Super~Single~Mama]

Originally Posted by slmommy 

Originally Posted by prosciencemum 

That is really worrying. How do childhood vaccinations work in the US for the uninsured? I guess children in most (all?) states can get free medical care if their family can't afford it, or is that just naivety on my part? 

Federally funded Vaccines For Children program (CDC) provides no cost vaccines for under/un-insured/medicaid and eligible children can receive everything ACIP recommends.

What are the eligibility parameters for this program?

[Rrrrrachel]

There are various programs to help people who can't afford health care, especially for children, but there are a lot of gaps in the system, too.  That's assuming the people that do qualify for the program even know about it.  Even for people who do have health care a co pay can be a major barrier to preventative care.

I'm sure lots of people will read that and think I'm overreacting or overstating the problem, but I'm really not.  The statistics on vaccine coverage by various measures of poverty are very telling. I think it's difficult if you've had a life of some privilege (and by privilege I don't just mean rich, I mean things like white, raised by both parents, graduated high school, etc) to understand the decisions that families make in these situations, especially when poverty is so often linked to a lack of adequate information and education about things like health care.

[slmommy]

Vaccine for Children and eligibility parameters can be found here:

http://www.cdc.gov/vaccines/programs/vfc/default.htm

I don't know about state and local programs... I am not living in the US at the moment. 

Looks like that happens too, this is what came up first for me in google:

JACKSON, Miss. - In recognition of National Infant Immunization Week (NIIW), the Mississippi State Department of Health (MSDH) is offering free routine immunizations for infants and children through 18 years of age at all county health departments next week (April 23-27).

http://msdh.ms.gov/msdhsite/_static/23,12239,341.html

[Serenity Now]

Some cities offer free vaccination clinics, no questions asked. I know in San Diego they had such a clinic and anyone who walked in, no matter their immigration status, could get vaccinations. They had a lot of people from Mexico drive over the border for vaccines, which was part of the point. A lot of VPD's are brought over from Tijuana, and the health professionals were hoping that this would help. Its too bad that all areas do not offer something similar, for those who want vaccines but can't get them do to their marginalized status or finances.

I thought adults did not get the TDaP, but the TDP? Has that changed? It has been 10 years since I had my booster, so I am not up on the newest adult vaccines. I am pregnant now, so I doubt I could get it anyway.