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#1 of 35 Old 02-16-2009, 07:23 PM - Thread Starter
 
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I am possibly vaccinating 5 yr old and almost three yr old with 3rd dose quadracel and 1st dose (respectively). Reason is to help protect 4 week old dd from pertussis outbreak here. Does that make sense considering we frequently hang out with kids who aren't vaccinated? I am not worried about older kids getting pertussis but it can be an awful illness in babies. I won't be vaccinating her until she is older. Thanks for your advice...
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#2 of 35 Old 02-16-2009, 07:34 PM
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no it doesnt make sense, since the disease can still be transmitted regardless of whether a person catches P or not if they come in contact with it they can pass it on - to the 4 week old, and to the unvaccinated children, etc. even if your child is hanging out with vaccinated children, if they have come into contact with P it can get spread around.
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#3 of 35 Old 02-16-2009, 07:38 PM
 
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If the outbreak is currently happening, I'm not sure the 1st dose of the vaccine would offer up much protection since it's a series of vaxes. Also, if the baby is hanging out with the unvaxed kids that have pertussis (or rather, with any kids that have pertussis), she is likely to get sick from those kids regardless of you older children's vaccine status. You could also be a carrier.

(I guess in short, if there's a current outbreak, regardless of vaxed status, you and your older children can still act as carriers.)

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#4 of 35 Old 02-16-2009, 08:14 PM - Thread Starter
 
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Right. Thanks. I forgot that many vaccinated children still get the disease so really the only way to protect youngest dd is to vaccinate her at 2 months. It sickens me to consider vaccinating her so young but it would kill me if she contacted pertussis. (I thought she was getting it a couple weeks ago and almost went crazy thinking about what could happen to her)
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#5 of 35 Old 02-16-2009, 08:19 PM
 
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Nope, won't help a bit, I understand that it is given in a series. I agree with what the other posters have listed.
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#6 of 35 Old 02-16-2009, 08:23 PM
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sorry to hear the scare tactics have gotten to you.

are you breastfeeding? thats the best thing you can do to protect against these things.
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#7 of 35 Old 02-16-2009, 09:32 PM - Thread Starter
 
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See I don't really think that in the case of pertussis that the scare tactics are
exaggerated. I have heard of infants that became very, very sick with the disease and I don't think I would cope very well with my little dd struggling so hard with the coughing (turning blue, vomiting etc) for weeks and the possibility of worse. I have read about sodium ascorbate on this site and the whole family is taking this currently and I am breastfeeding, although contacted it passively through immunization so not as much benefit there. Thanks for the replies- any other food for thought would be appreciated.
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#8 of 35 Old 02-16-2009, 09:52 PM
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I guess I'm more concerned with death then whooping cough. thankfully, when EVERYONE in my house got whooping cough (fully vaccinated for it) my DS2 (the only unvaccinated in the house, who was breastfeeding at the time and still is) did not catch it. it lasted months and it was a pain, but the vax didnt protect dd or ds1 and my unvaccinated child was "lucky" I suppose, though I think the fact he was EBF at the time helped. He wouldnt have been old enough to be vaccinated against it at that point anyway, he was just a newborn still.
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#9 of 35 Old 02-16-2009, 09:56 PM
 
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Originally Posted by Dandelionkid View Post
See I don't really think that in the case of pertussis that the scare tactics are
exaggerated. I have heard of infants that became very, very sick with the disease and I don't think I would cope very well with my little dd struggling so hard with the coughing (turning blue, vomiting etc) for weeks and the possibility of worse. I have read about sodium ascorbate on this site and the whole family is taking this currently and I am breastfeeding, although contacted it passively through immunization so not as much benefit there. Thanks for the replies- any other food for thought would be appreciated.
Yeah, when it comes to tiny infants, I think it's understandable to be scared of pertussis.
I think choosing to vax a baby for it can be a reasonable choice, so don't think I'm trying to steer you away from that...but ftr, you probably (not definitely, but probably) have "natural immunity" to pertussis by now. Pertussis is so common that we all catch it fairly regularly and stay somewhat immune most of the time that way. And there are pertussis-specific antibodies in breastmilk, although their actual effectiveness has never been studied, so no one knows how much protection that gives.
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#10 of 35 Old 02-16-2009, 10:25 PM
 
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Originally Posted by Dandelionkid View Post
Right. Thanks. I forgot that many vaccinated children still get the disease so really the only way to protect youngest dd is to vaccinate her at 2 months. It sickens me to consider vaccinating her so young but it would kill me if she contacted pertussis. (I thought she was getting it a couple weeks ago and almost went crazy thinking about what could happen to her)
No, the vaccine is NOT the only way to protect her. You can also breastfeed her, wash your hands frequently, not allow kids to touch her face after picking their noses, etc. Regular, normal "let's keep healthy" routines will help prevent pertusses as well as diseases without special names.

Ruth, single mommy to Leah, 19, Hannah, 18, and Jack, 12
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#11 of 35 Old 02-17-2009, 01:11 AM
 
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I'm going to be alone here, but it does make sense, and it's why we vaxed our 2.5 year old.
I was due with a new baby right before pertussis season, and I knew it was a vax I would eventually get for her anyway, so I went ahead and started the doses before the baby came so by the time it was this time of year she'd have a few doses in her (the first few doses must be at least 4 weeks apart, and there needs to be at least 6 months between the 3rd and 4th dose)

Pertussis is so so scary in small babies. But I also hate giving such a reactive shot to such a small baby. So I feel it's a compromise to make sure those around baby are up to date.

YES, it is POSSIBLE to carry the bacteria into the home even if you are immune. If an immune child gets the germ on their hand (say from playing with an infected kid) and then doesn't wash hands before coming home, then touches baby with his germy hand before the germ dies away, then the baby could get it.
However, the germ is only going to live on his skin for a short period of time, is not going to multiply, and is easily taken care of by some hand washing.

Now, if the same child was NOT immune, plays with the infected neighbor kid, and comes down with it, he will actually be CONTAGIOUS with it. The germ will invade his body and multiply, and every time he coughs or sneezes the germs will fly out onto surfaces, his hands, the baby... And not just for a short time like the first scenario, but for a LONG time he'll be spreading the germs.
He will be spreading germs around MUCH better than that one little germ that he carried in on his dirty hand before the host-less germ died away.

So no, being immune does not COMPLETELY prevent transmission, but compared to how much an infected child transmits the disease, it is a GREAT reduction.

I wouldn't "count on" breastfeeding as a tried and true way to prevent pertussis. Yes breastfeeding is awesome and strengthens the immune system and passes antibodies, but it is not magic. Look at the history of pertussis, and you'll see that the period of most pertussis infant deaths is also the same time period were bottle feeding was practically non-existent.

I don't feel comfortable vaxing a small infant with dtap (my own personal gut feeling) but I feel fine after 2+ years of age.
So if your kids are going to eventually get it ANYWAY, why not do it now to create a little bit of a "wall" for your baby, rather than vaxing the baby. Maybe it's just me, but I just feel a whole lot more comfortable vaxing older kids than little babies. (especially since many times it requires fewer doses)

Also, yes it takes several shots to get the peak immunity, but that does not mean that the shots leading up to the last one are completely useless. Each shot (starting with the first one) increase immunity by a certain percentage. (and I believe you said your oldest has already received several, anyway?) So even if you only have time for one or 2 doses, it does lower the chances at least somewhat (and decreases the severity if caught)

You must not be in the US, as I don't recognize that brand name. So you may want to look up the catch up schedule for dosing intervals. the DTaP (US) can be given as close as 4 weeks together for the first 3 doses, but then no closer than 6 months between the 3rd and 4th and 4th and 5th (and if the 4th dose is after 4 yrs old, the 5th is not necessary)

Good luck, it's a hard decision.
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#12 of 35 Old 02-17-2009, 01:38 AM
 
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Originally Posted by ~Ryleigh's Mommy~ View Post
YES, it is POSSIBLE to carry the bacteria into the home even if you are immune. If an immune child gets the germ on their hand (say from playing with an infected kid) and then doesn't wash hands before coming home, then touches baby with his germy hand before the germ dies away, then the baby could get it.
However, the germ is only going to live on his skin for a short period of time, is not going to multiply, and is easily taken care of by some hand washing.

Now, if the same child was NOT immune, plays with the infected neighbor kid, and comes down with it, he will actually be CONTAGIOUS with it. The germ will invade his body and multiply, and every time he coughs or sneezes the germs will fly out onto surfaces, his hands, the baby... And not just for a short time like the first scenario, but for a LONG time he'll be spreading the germs.
He will be spreading germs around MUCH better than that one little germ that he carried in on his dirty hand before the host-less germ died away.
Actually this is NOT how it works. The pertussis vaccine does not prevent you from CONTRACTING pertussis. All it prevents is the action of the TOXIN. Doesn't do anything to prevent the bacteria. The vaccinated child can still get pertussis, cough, sneeze, spread it to kingdom come and back but not get the "whoop" cough (b/c the vax prevents the TOXIN from reproducing)

-Angela
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#13 of 35 Old 02-17-2009, 01:51 AM
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I agree if your choices are vax the baby or vax the older child that it's better for an older child then a smaller baby - but I have to back up Angela on this one - in my mind it just becomes an unnecessary risk to the older child. Kind of reminds me of a book I read not to long ago... My sister's keeper.
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#14 of 35 Old 02-17-2009, 02:11 AM - Thread Starter
 
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Yeah, when it comes to tiny infants, I think it's understandable to be scared of pertussis.
I think choosing to vax a baby for it can be a reasonable choice, so don't think I'm trying to steer you away from that...but ftr, you probably (not definitely, but probably) have "natural immunity" to pertussis by now. Pertussis is so common that we all catch it fairly regularly and stay somewhat immune most of the time that way. And there are pertussis-specific antibodies in breastmilk, although their actual effectiveness has never been studied, so no one knows how much protection that gives.
That makes sense! I probably do have natural immunity by now. Thanks for bringing that up.

Ryleighs mommy:
Quote:
So if your kids are going to eventually get it ANYWAY, why not do it now to create a little bit of a "wall" for your baby, rather than vaxing the baby. Maybe it's just me, but I just feel a whole lot more comfortable vaxing older kids than little babies. (especially since many times it requires fewer doses)
Yes I did plan at one point to vaccinate starting at age 2. I hate vaccines. I hate the politics behind them and can't trust those that promote them. On the other hand, I feel fearful about my kids being around these diseases. I'll probably go ahead with the quadracel for the oldest two and keep going at it slowly.
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#15 of 35 Old 02-17-2009, 04:33 AM
 
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YES, it is POSSIBLE to carry the bacteria into the home even if you are immune. If an immune child gets the germ on their hand (say from playing with an infected kid) and then doesn't wash hands before coming home, then touches baby with his germy hand before the germ dies away, then the baby could get it.
However, the germ is only going to live on his skin for a short period of time, is not going to multiply, and is easily taken care of by some hand washing.

Now, if the same child was NOT immune, plays with the infected neighbor kid, and comes down with it, he will actually be CONTAGIOUS with it. The germ will invade his body and multiply, and every time he coughs or sneezes the germs will fly out onto surfaces, his hands, the baby... And not just for a short time like the first scenario, but for a LONG time he'll be spreading the germs.
He will be spreading germs around MUCH better than that one little germ that he carried in on his dirty hand before the host-less germ died away.
It doesn't work like that, though.

http://pediatrics.aappublications.or...ull/104/6/1381

Quote:
Case definition has been particularly problematic in all of the recent DTaP vaccine efficacy trials. For uniform comparative purposes a case definition was suggested by a WHO expert committee.39 This definition required 21 days of paroxysmal cough plus laboratory confirmation of pertussis in the subject or household contact. There are 2 problems with this definition. The first is that a substantial number of B pertussis infections in unvaccinated children are mild and would not meet the case definition. The second is that all pertussis vaccines tend to modify duration and severity of disease rather than completely preventing illness

http://www.cdc.gov/ncidod/eid/vol6no5/pdf/srugo.pdf

Quote:
The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.
http://www.ima.org.il/imaj/ar06may-2.pdf

Quote:
Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population [19].
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#16 of 35 Old 02-17-2009, 12:13 PM
 
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WHAT?!?

I am so confused and a little bit angry right now.

Whenever I saw people say that "vaxing doesn't prevent transmission", I always assumed they misunderstood how transmission occurs (in someone sick vs someone simply carrying a germ on their hand) I am not able to access all the posted links, but I understand what you are saying about it preventing the toxin and not the disease. I get what you mean now. Maybe from now on, whenever someone makes the comment about not preventing pertussis transmission, they need to clarify how pertussis vax is DIFFERENT than the other vaxes this way, so that they don't get brushed off?? (just a suggestion since I know there are probably a lot of people who would brush that statement off as just another "vaxes don't actually work" statements. And obviously if we thought vaxes didn't work at all, we wouldn't be in the selective forum)
I apologize to the OP and anyone reading my ignorant post.

I am so angry right now. WHY, if the vax doesn't prevent transmission, do they force me (as a health care provider) to get this shot every time I start a new job somewhere "to protect my patients"??? Why do they run those ads about "parents, protect your infants by getting yourself vaccinated" ??
I am also mad, because now this means if I want to give protection to my baby, now I have to get him the shot
And mostly I am so mad at myself for not knowing this.

Is this the only vax that works this way??
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#17 of 35 Old 02-17-2009, 12:25 PM
 
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I only read half the responses at the moment, but I believe whopping cough is usually carried by (and thus transmitted by) adults, primarily adults working in hospitals. I don't vax and there is (supposedly) an outbreak of it going on here in the Philly area. I was concerned about her possibly catching that, among other diseases, so I just keep her out of hospitals (no visiting people in there).

Good Luck!

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#18 of 35 Old 02-17-2009, 12:27 PM
 
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One study talks about whole cell vax and another about acellular.

let me get this straight: trasmission happens with any vax a person has had in the past, DTaP or DTP.

correct?
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#19 of 35 Old 02-17-2009, 12:30 PM
 
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~Ryleigh's Mommy~ :

don't be too hard on yourself this is A LOT of new info to deal with, esp when we are also having to think of so many other things throughout the day (and quite often, night too, right?)

hang in there... i am trying to too...
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#20 of 35 Old 02-17-2009, 12:40 PM
 
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Is this the only vax that works this way??
I've heard mixed things on diphtheria possibly working that way as well.

IPV does for sure.

-Angela
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#21 of 35 Old 02-17-2009, 02:27 PM
 
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I have actually come across a few studies that demonstrate pertussis vaccination preventing transmission, or claim to...so I think the question is not yet resolved:

http://www.uga.edu/rohanilab/paperpdfs/lancet2000.pdf

Quote:
Finally, we investigated the efficacy of vaccination by
studying the pattern of fade-outs—ie, the frequency and
duration of reports of no cases in individual locations (figure
2).3 A very large increase in both number and duration of
fade-outs occurred in the vaccine era, consistent with spatial
synchronisation of epidemic troughs.5 The importance of
these observed changes in the fade-out structure very much
depends on the frequency of mild or subclinical infections.
In the absence of unequivocal evidence that the occurrence
of symptomless infections radically increased after
vaccination, the striking changes strongly indicate that
vaccination has successfully reduced pertussis transmission.
http://www.sciencedirect.com/science...4c75907aafafa0


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#22 of 35 Old 02-17-2009, 02:52 PM
 
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Also, another thing I have thought about:

we have ample evidence that most transmission of pertussis to infants is from adult/adolescent to child and not sibling to child. And we have tons of studies on adults/older children being the biggests transmitters of pertussis. If the vaccine did NOT prevent at least some transmission, wouldn't younger children be larger resevoirs of the disease than science is showing them to be?

to me, it seems like vaccine immunity wanes, adults do not get boosters, and then they are able to transmit the disease.

ETA: I should qualify this to say that these facts seem to tell me that the vaccine seems to be effective at preventing some transmission.

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Originally Posted by ~Ryleigh's Mommy~ View Post
WHAT?!?
they force me (as a health care provider) to get this shot every time I start a new job somewhere "to protect my patients"??? Why do they run those ads about "parents, protect your infants by getting yourself vaccinated" ??
I am also mad, because now this means if I want to give protection to my baby, now I have to get him the shot
((HUGS)) Probably because its the only way to get adults to vaccinate themselves.
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#24 of 35 Old 02-17-2009, 04:11 PM
 
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I have actually come across a few studies that demonstrate pertussis vaccination preventing transmission, or claim to...so I think the question is not yet resolved:

http://www.uga.edu/rohanilab/paperpdfs/lancet2000.pdf



http://www.sciencedirect.com/science...4c75907aafafa0


brb with more, i know I have them I just have to locate them but making lunch now
I haven't read the second one yet, but the first one says:

Quote:
We now have access to a much more extensive dataset
(both temporally and spatially) than was available to Fine
and Clarkson.4 We found that the onset of pertussis
vaccination coincided with a significant increase in the
interepidemic interval, from 2·0–2·5 to nearly 4 years in the
ten largest cities of England and Wales
(figure 1).
Why are they saying the epidemic cycle was 2 or 2 and a half years? I've seen evidence that there are "mini peaks" every 2.5 years within the 5 year epidemic cycles, but they're small enough to where they're not looked at by "pertussis epidemiologists" when they're exploring time trends. And either way, we do still have those "mini peaks" today. I'll find the study in mind if you want.

Quote:
Also, another thing I have thought about:

we have ample evidence that most transmission of pertussis to infants is from adult/adolescent to child and not sibling to child. And we have tons of studies on adults/older children being the biggests transmitters of pertussis.
Of course infants are going to usually catch it from an age group that's over one. And regarding transmission on a population level, whatever age group represents the largest % of the population will transmit the most pertussis.


Quote:
If the vaccine did NOT prevent at least some transmission, wouldn't younger children be larger resevoirs of the disease than science is showing them to be?
Child-to-child transmission in well documented and common. The only people who don't spread pertussis around are infants, because they're not mobile.

Quote:
to me, it seems like vaccine immunity wanes, adults do not get boosters, and then they are able to transmit the disease
The problem with that theory is the evidence indicating that most people are re-exposed and mildly infected long before vax immunity wanes. And then that happens over and over again throughout life.



Quote:
Originally Posted by ~Ryleigh's Mommy~
I am so angry right now. WHY, if the vax doesn't prevent transmission, do they force me (as a health care provider) to get this shot every time I start a new job somewhere "to protect my patients"???
That's a really good question, isn't it?
Here's the ACIP's recommendations for the TDaP.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5517a1.htm
http://www.cdc.gov/mmwr/PDF/rr/rr57e0514.pdf
And a discussion, here:
http://www.mothering.com/discussions...456&highlight=

Can you find any reference to evidence that vaccinating adults will prevent transmission? I can't. The thinking seems to go "Adults catch pertussis often, so it makes sense to vaccinate them", completely ignoring the lack of evidence supporting the vaccine's ability to prevent transmission.

Quote:
Why do they run those ads about "parents, protect your infants by getting yourself vaccinated" ??
They give a disclaimer in their small print:

http://www.adacel-locator.com/index....E&P=HowS_pread

Quote:
* It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants.3
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#25 of 35 Old 02-17-2009, 04:20 PM
 
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One study talks about whole cell vax and another about acellular.

let me get this straight: trasmission happens with any vax a person has had in the past, DTaP or DTP.

correct?
Yep.

http://scholar.google.com/scholar?q=...r=&btnG=Search
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#26 of 35 Old 02-17-2009, 04:40 PM
 
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Quote:
Originally Posted by carrie
http://www.sciencedirect.com/science...4c75907aafafa0


brb with more, i know I have them I just have to locate them but making lunch now
Ok, that second one.
I don't have access to the fulltext, but it appears to have issues because it's not blinded, which means it might just mean "family members of unvaxed hacking toddlers with bad cases of wc are more likely to be correctly diagnosed themselves when they catch it, too."

But even if the effect is real in that study, it's only there for the whole cell vax...the acellular one was only found to be 6% effective there. So...
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#27 of 35 Old 02-17-2009, 04:44 PM
 
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Doesn't the CDC and the package insert say Diptheria is still present on the nares?



I thought about this irony when the Parenting magazine gave half a page to the "cocoon effect" warning parents to make sure everyone who came near the near baby was fully vaccinated and up to date. I thought that was laughable.

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#28 of 35 Old 02-17-2009, 04:55 PM
 
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IF
* It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants.3


can be printed so everyone can see, so how can other studies such as this one below say the opposite out loud??


Transmission of Bordetella pertussis to Young Infants
[Original Studies]

Conclusions: This study provides solid evidence that among infants for whom a source case was identified, household members were responsible for 76%-83% of transmission of Bordetella pertussis to this high-risk group. Vaccination of adolescents and adults in close contact with young infants may thus eliminate a substantial proportion of infant pertussis if high coverage rates can be achieved.

http://www.pidj.org/pt/re/pidj/abstr...195629!8091!-1



I don't get it.
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#29 of 35 Old 02-17-2009, 06:21 PM
 
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so does it seem that the whole cell preventing more transmission? or was possibly better? can you comment on these, too; i would love to hear your thoughts:

http://www.journals.uchicago.edu/doi/abs/10.1086/322639

Quote:
Thus, mass vaccination of children with pertussis toxoid decreases spread of B. pertussis in the population.

http://www.uga.edu/rohanilab/paperpd...ection2005.pdf
Quote:
The observed changes suggest that vaccination against measles and pertussis induced a drop in their transmission. Similarities in disease dynamics to those of temperate regions such as England and Wales were also observed.

"Parents are simply trustees; they do not own the bodies of their children"-Norm Cohen  Martial arts instructor intactlact.gifhomebirth.jpgnak.gif and mom to 4: DD1 (1/05) DS (7/06) DD2 (5/08) DD3 (2/11)
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#30 of 35 Old 02-17-2009, 08:38 PM
 
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For that first study, here's what they think:
Quote:
If the incidence of pertussis had been affected only by individual vaccine efficacy (point estimate, 71% after 3 doses [2]), vaccination rate (56% had received 3 doses at the end of the project), and disease-induced immunity (10%; table 2), it should have decreased by <50% and the decrease should have been evident only toward the end of the mass vaccination project. Instead, pertussis, as diagnosed by positive culture results, had decreased by >90% after 2 years.
They're considering infants who have had 2 doses "unvaccinated", but according to serology, just one dose gets most babies 80-90% of the way to what they think is the "correlate of immunity" (for all components of the 5 component vax, including pertussis toxin.)

So you need to look just at kids under 2 months (or other completely unvaxed infants). to really see if a herd effect is happening.

Which...that's been thought of before:

http://whqlibdoc.who.int/hq/1999/WHO_V&B_99.03.pdf

Quote:
In discussion, Dr Cherry pointed out that in Japan also the reported pertussis incidence in children under three months of age has not declined substantially with return to a high vaccination coverage.
So, instead of looking at this as evidence that the vax doesn't prevent transmission, they just decided to create the tdap and vax adults and see if that will work.

But the biology also indicates that the vaccine doesn't teach your immune system how to clear the bacteria.

http://iai.asm.org/cgi/content/abstract/68/12/7175

Quote:
In summary, booster immunization of adults with acellular pertussis vaccines was not found to increase bactericidal activity over preimmunization levels. Identifying ways to promote bactericidal immune responses might improve the efficacy of acellular pertussis vaccines.
...and there are more studies like that.

Also, that study was the monocomponent "pertussis toxin only" vax.

Look at this:

http://iai.asm.org/cgi/reprint/58/10/3445

Quote:
This is consistent with animal experiments which suggest that adhesins not targeted by the vaccine may permit a bit of colonization and that neutralization of pertussis toxin would limit the severity of the disease but would not have an impact on the initial stages of infection.
So, in a nutshell, I think that study is more "evidence that one or two doses of a monocomponent pertussis vaccine are significantly effective against a severe case of pertussis in infants" than evidence of herd immunity from the vaccine.

I'll read the second study and come back...
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