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would you - the mother - rather have had pertussis or the vaccine?

post #1 of 25
Thread Starter 

Everyone agrees (I am sure!) that pertussis in an infant is not a good thing.  They have a high mortality rate from it.

 

The current way we combat pertussis is to hit people hard with a somewhat ineffective vaccine.  The current plan starts with shots in utero and is followed by a fairly large number of shots spread out throughout your lifetime (with 4 shots by 18 months).  Ugh and sigh.

 

I have been thinking lately that if I were planning another baby, I would prefer to actually get pertussis while not pregnant, and pass along immunity to my newborn through birth and breastfeeding.

 

Pertussis does not seem like a walk in the park - but it also does not seem horrendous or typically dangerous in older children and adults.  A few links:

 

http://www.patient.co.uk/health/whooping-cough

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf

 

Speaking for myself, I would rather have had pertussis as an older child or adult and then be able to pass on the immunity to pertussis through birth and breastmilk.

 

I also read somewhere that pertussis used to be a disease of childhood (but not typically infancy) and that vaccination has morphed this disease into a disease that affects more infants, which is obviously not good. Has anyone read anything like that or have any links?

 

So, this is my long winded way of asking, if you had the choice - would you:

 

Assume the risks of pertussis yourself, and then pass on some immunity to your baby through birth and breastfeeding?

 

or

 

Not assume the risks of pertussis to yourself, and try to use vaccination to keep pertussis at bay in infants...

 

or 

 

other?  (please explain)

post #2 of 25
I'm biased on this subject, as I had pertussis as a child. I spent one whole summer sick, which was crappy, but otherwise it wasn't too bad. It affected my mother probably worse than me! She was always trying to stop the coughing I was doing at night, so my father could sleep. Didn't get much sleep herself, I expect.

Anyway, I like the fact that I had it to pass along the immunity. Would I want it as an adult? Hmmm. It would be difficult to take good care of existing children with pertussis. And if I was working, I don't know how an emloyer would react to an employee coughing for so many weeks.

Still, overall, I'd vote for natural immunity.
post #3 of 25

I'd want to have it myself

post #4 of 25

I had pertussis as a child. I am 39. I was vaccinated for everything back during my childhood, but I don't recall anything other than MMR, polio and DtaP when I was a kid. I vote natural immunity before vaccination.

post #5 of 25

I'd always want natural immunity over a vaccine... I've never heard of being vaccinated for it during pregnancy though, I don't think I've ever been offered a pertussis vaccine. The only vaccine I recall getting in my life was tetanus when I was impaled by a giant rusty nail as a teenager... other than that, I didn't even know adults get vaccines.

post #6 of 25
post #7 of 25
Thread Starter 

Escaping - here is a link.

 

http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

 

"In October 2012, the Advisory Committee on Immunization Practices (ACIP) voted to recommend that health care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks gestation"

 

Here is what they say about safety:

 

"ACIP concluded that there is no elevated frequency or an unusual occurrence of adverse events among pregnant women who have received Tdap vaccine, or in their newborns"

 

I have no idea how they determined that is true.  

 

Here is a Canadian Article on it - it looks like it may be recommended for Canadian women, too, but as of press time few seemed to be getting it.

 

The CBC said this about safety:

http://www.cbc.ca/news/health/story/2012/10/24/whooping-cough-vaccine-pregnancy.html

 

"Despite the overwhelming vote tally, several members of the panel voiced uneasiness with a lack of data on how effective and safe such a recommendation will be for mothers and newborns.

CDC officials acknowledge they have data on only hundreds of women who got the shots during pregnancy. What's more, the vaccine is only licensed to be given to adults once. Under the new recommendation, women who raise large families may be getting the vaccine three or four or more times."

Do read the whole article though, it is an easy read and there is a lot of interesting stuff in it.  

post #8 of 25

Per the CDC, getting pertussis does not confer lifelong immunity to the disease.  You can get this more then once.

 

I have, personally, spent enough time being miserable sick.  I would rather get the pertussis vaccine then get the disease.  If I was concerned about the vaccine's effect on infants, I would still want to get the vaccine myself, to avoid bringing the disease home.  I'm an adult, I feel okay about taking this risk for myself so long as I'm not currently immune-suppressed.

post #9 of 25

I probably had it at some point. I had everything else, chicken pox, measles, rubella, etc. I'm over 45 and was only vaccinated for Polio and small pox. Probably tetanus too at some point.

post #10 of 25
Thread Starter 

meepy - 

 

http://www.ncbi.nlm.nih.gov/pubmed/15876927

 

"A review of the published data on duration of immunity reveals estimates that infection-acquired immunity against pertussis disease wanes after 4-20 years and protective immunity after vaccination wanes after 4-12 years. Further research into the rate of waning of vaccine-acquired immunity will help determine the optimal timing and frequency of booster immunizations and their role in pertussis control."

 

The above is kind-of old, though (2005).  Current research is showing pertussis immunity wanes pretty quickly after the fifth shot  (link:http://healthland.time.com/2013/03/11/protection-from-pertussis-vaccine-wanes-over-time/ )

 

The other issue is how effective is the protections.  The vaccine offer  55-80 % efficacy (maybe); I don't know how effective natural immunity is, but I bet it is better. I will see what I can find.  

 

Also - As a healthy adult I think it is perfectly reasonable to use tdap outside of pregnancy to help prevent an infant getting pertussis.  The question is if the mother getting pertussis (hopefully not while she has a newborn, obviously!) and passing on natural immunity might offer better protection, and whether mothers would be willing to get pertussis (with its risks) in hopes of passing on immunity to their children.   

post #11 of 25
Thread Starter 

Ok - not what i was looking for, but very interesting!

 

This article argues against teen boosters of pertussis as it fears it might switch the burden of the disease onto older, child-bearing adults.

 

http://www.medscape.com/viewarticle/752974

 

"….it is an open question as to what extent boosters should be offered to older age groups or if natural infections would be preferable. On the one hand, circulating B. pertussis may be hazardous to the youngest unvaccinated infants. On the other hand, subclinical natural boosters might be beneficial to population immunity. As the duration of immunity is shorter after vaccination than after natural infections, an unwanted consequence of adolescent boosters might shift the infection peak to older child-bearing adults."

post #12 of 25
Quote:
Originally Posted by kathymuggle View Post The question is if the mother getting pertussis (hopefully not while she has a newborn, obviously!) and passing on natural immunity might offer better protection, and whether mothers would be willing to get pertussis (with its risks) in hopes of passing on immunity to their children.   

 

I get that that's the question.  I'm saying that my answer to it is NO, I am not willing to take on the risks of pertussis over the risks of the vaccine, even when I qualify as a healthy adult. 

post #13 of 25
Quote:
Originally Posted by fruitfulmomma View Post

Escaping, here is the adult schedule - http://www.cdc.gov/vaccines/schedules/downloads/adult/mmwr-adult-schedule.pdf

Thanks for the link.... wow.... that is a lot of vaccines... our schedule doesn't even have a section for adults, other than recommending the flu shot which no one I know ever even gets.... http://www.health.gov.on.ca/en/public/programs/immunization/docs/schedule.pdf

post #14 of 25
Thread Starter 
Quote:
Originally Posted by MeepyCat View Post

 

I get that that's the question.  I'm saying that my answer to it is NO, I am not willing to take on the risks of pertussis over the risks of the vaccine, even when I qualify as a healthy adult. 

Got it.  Thanks for clarifying.  

 

I was not really looking at it from a risks of vaccinating versus risks of disease thing (although they always play into things) - but more from an effectiveness point of view.  Which option - allowing people to get pertussis so they pass on immunity to their infant  or our current schedule  - offers baby the most protection?

 

It might be mid ground is an option for some folks - vaxxes at 2 and 4 months to protect infants, but then letting immunity wear off so they can acquire natural immunity (which they will then be able to pass on to their future offspring).

 

Trying to vaccinate pertussis out of existance does not seem to be working.  

post #15 of 25
Quote:
For tetanus, diphtheria, and acellular pertussis (Tdap) 
vaccine, recommendations have been expanded to include 
routine vaccination of adults aged 65 years and older and for 
pregnant women to receive Tdap vaccine with each pregnancy.

http://www.cdc.gov/vaccines/schedules/downloads/adult/mmwr-adult-schedule.pdf

 

 

 

http://www.ncbi.nlm.nih.gov/pubmed/15876927

 

 

 

Quote:
"A review of the published data on duration of immunity reveals estimates that infection-acquired immunity against pertussis disease wanes after 4-20 years and protective immunity after vaccination wanes after 4-12 years. Further research into the rate of waning of vaccine-acquired immunity will help determine the optimal timing and frequency of booster immunizations and their role in pertussis control."

So, WHY do women need a tdap booster with EVERY pregnancy if the vaccine hasnt worn off yet? suppose they get pregnant every year for 4-5yrs?  That's a lot of toxin buildup, i'd think, in the mom.  

post #16 of 25

I recommend Hilary Bulter's info on all things whooping cough, her articles are always impeccably referenced and always tons of quotes.

 

http://beyondconformity.org.nz/resources/whooping-cough

 

Here is her info on immunity 

 

http://www.beyondconformity.co.nz/_blog/Hilary's_Desk/post/Whooping_cough_immunity/

 

I would go for natural immunity with an effective immune response to ACT than a sub par vaccine induce immunity any day.

post #17 of 25
Thread Starter 
Quote:
Originally Posted by emmy526 View Post

 

 

 

 

So, WHY do women need a tdap booster with EVERY pregnancy if the vaccine hasnt worn off yet? suppose they get pregnant every year for 4-5yrs?  That's a lot of toxin buildup, i'd think, in the mom.  

I think they are hoping that some of the immunity will pass to the fetus with each vaccination.  So while mom might not need a booster (if she had one recently)  - they are hoping it will benefit the baby.

 

I have heard that too many tetanus vaccines are unsafe.  I can try to hunt it up later if anyone is interested.  

post #18 of 25
Quote:
Originally Posted by kathymuggle View Post

I think they are hoping that some of the immunity will pass to the fetus with each vaccination.  So while mom might not need a booster (if she had one recently)  - they are hoping it will benefit the baby.

 

I have heard that too many tetanus vaccines are unsafe.  I can try to hunt it up later if anyone is interested.  

 

My understanding is that the pertussis booster for pregnant moms is to prevent those women from getting pertussis and passing it on to the children.  The reasoning does not assume that any immunity is passed on to the fetus by any means, either before or after birth.  If mom had recently had a booster, by this reasoning, she wouldn't need one during pregnancy.  (I don't have a citation for this.  It's the explanation my doctor gave me.)

 

Many young and basically healthy women have very little routine contact with their doctors outside of pregnancy - I know, for example, that for a long time my insurance only paid for one routine physical every five years.  When I got pregnant during that period, I hadn't seen my GP in a long time, and I had not had a pertussis booster in over ten years.  It made sense for my OB (my key point of medical contact) to ask about my vaccine status and whether I wanted a booster.  I suspect that the standard recommendations for vaxes for pregnant women assume that women may not see their doctors much while not pregnant, leaving them in a place where catchup vaccines at the OB's office are helpful.

post #19 of 25

CDC rationale (reuters article)

 

 

Vaccinating pregnant women serves the dual purpose of keeping moms from contracting whooping cough and passing it to their infants as well as allowing some immune cells to pass to babies through the placenta.

"It turns out that immunity wanes pretty quickly," said Dr. H. Cody Meissner, a pediatrician from the Tufts University School of Medicine in Boston who is on the CDC's immunization committee.

"Without boosting with each pregnancy, a mother's immunity will wane and she will have much less immunity to pass on to the baby," [emphasis mine] Meissner told Reuters Health.

 

ETA: sorry about the advertising in the format, no idea how to get rid of it.

 

 

 

 

 

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post #20 of 25
Quote:
Originally Posted by Mirzam View Post

CDC rationale (reuters article)

 

 

 

 

 

 

 

 

 

Quote:
"It turns out that immunity wanes pretty quickly," said Dr. H. Cody Meissner, a pediatrician from the Tufts University School of Medicine in Boston who is on the CDC's immunization committee.

wonder how 'cooked the books' were....

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