New York Times Article on the Whooping Cough Outbreack in Washington State. - Mothering Forums

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#1 of 49 Old 05-14-2012, 02:22 AM - Thread Starter
 
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Thought this article might be helpful to people currently considering the pertussis/whooping cough vaccination choice: http://www.nytimes.com/2012/05/13/health/policy/whooping-cough-epidemic-hits-washington-state.html


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#2 of 49 Old 05-14-2012, 07:59 AM
 
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How exactly is that article helpful, when it completely leaves out the fact that many researchers believe that pertussis has mutated, that the vaccine is not as effective as previously believed, and that the majority of those who have been infected were fully vaccinated?
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#3 of 49 Old 05-14-2012, 08:08 AM - Thread Starter
 
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Probably depends on your definition of helpful. I think it does hi-light the current concerns about whooping cough epidemics. 

 

It's a short article in the NYT. It's not going to have every caveat out there. But interestingly it does state both that the vaccination is dropping in effectiveness and that most of the children who got the disease have been vaccinated. So your comments make me wonder if you actually read it:

 

 

 

Quote from NYT article:

Dr. Thomas Clark, an epidemiologist at the C.D.C., said changes in the vaccine may be partly responsible. The formula was altered beginning in the early 1990s to reduce side effects, which means that its immunizing effects do not last as long, he said.

Most of the victims in the Washington outbreak and other recent ones received their early childhood vaccinations, Dr. Clark said. An early immunization, even if it does not keep a patient from getting the illness, generally produces a milder case, he said, since the victim would still have some residual resistance.

 

And as I understand it all viruses/bacteria mutate, some slowly, some much faster. This is why they have to keep reinventing the flu vaccine for each new year's versions of flu virus. 


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#4 of 49 Old 05-14-2012, 08:48 AM
 
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And as I understand it all viruses/bacteria mutate, some slowly, some much faster. This is why they have to keep reinventing the flu vaccine for each new year's versions of flu virus. 

They didn't reinvent the flu vaccine for the 2011-2012 flu season. They re-used the previous year's version. Yet they still insisted that people who had received it the year before needed to receive it again.
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#5 of 49 Old 05-14-2012, 08:51 AM
 
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The statistic that "most people who get infected are fully vaccinated" is completely worthless, a total red herring, and akin to saying "the sky is blue.". It belies a total misunderstanding of statistics and relative risk at best and is intentionally misleading at worst.
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The statistic that "most people who get infected are fully vaccinated" is completely worthless, a total red herring, and akin to saying "the sky is blue.". It belies a total misunderstanding of statistics and relative risk at best and is intentionally misleading at worst.

 

I disagree.  It's important for people to understand that they CAN get and transmit an illness despite having been vaccinated against that illness.  It may even help in terms of quarantining those who are ill.

 

I don't see how that's worthless. 

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#7 of 49 Old 05-14-2012, 09:03 AM
 
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We've discussed this before, and peer-reviewed, mainstream science studies have already been posted, clearly indicating that my statement is not completely worthless.  But I guess it's worth posting again:

 

http://www.fairwarning.org/2011/09/whooping-cough-vaccine-wears-off-quickly-researchers-say/

 

The new research, unveiled in a press briefing at a medical conference in Chicago Monday, indicated that “the vast majority” of those who became ill were fully vaccinated children, said Dr. David Witt, the lead researcher and chief of infectious disease at the Kaiser Permanente Medical Center in San Rafael, Calif.

 

 

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

 

We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization's case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.
 
 
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#8 of 49 Old 05-14-2012, 09:20 AM
 
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The statistic that "most people who get infected are fully vaccinated" is completely worthless, a total red herring, and akin to saying "the sky is blue.". It belies a total misunderstanding of statistics and relative risk at best and is intentionally misleading at worst.


Whether you like it or not, it is a fact. Parents should be given all facts in order to make an informed decision.

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#9 of 49 Old 05-14-2012, 09:53 AM
 
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The statistic that "most people who get infected are fully vaccinated" is completely worthless, a total red herring, and akin to saying "the sky is blue.". It belies a total misunderstanding of statistics and relative risk at best and is intentionally misleading at worst.


Whether you like it or not, it is a fact. Parents should be given all facts in order to make an informed decision.


 

Just like parents should know that vaccines aren't 100% effective. But knowing that "most children who get sick have been vaxed" doesn't tell us how likely a vaxed child is to get sick vs how likely it is for a non-vaxed child to get sick.

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#10 of 49 Old 05-14-2012, 10:45 AM
 
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I'm not saying the statement is wrong, it's just not very meaningful. It's absolutely expected that the majority of people who get infected in an outbreak are vaccinated. Even with highly effective vaccines that's the case.

Think about a 1000 student high school. Someone comes to school with pertussis. Assume the pertussis vaccine is 90% effective (in reality I think it's 80-95%, but that's from memory so take it with a grain of salt.). Say 95% of the students are vaccinated.

Of the 950 vaccinated students we would expect around ten percent, or 95 of them to still get pertussis. Even I all 50 unvaccinated students get it, still the majority of cases are in vaccinated students. Can you conclude from that that the vaccine is ineffective? Of course not, because when you compare the rates a vaccinated student was far less likely to acquire the disease.
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"The new research, unveiled in a press briefing at a medical conference in Chicago Monday, indicated that “the vast majority” of those who became ill were fully vaccinated children, said Dr. David Witt, the lead researcher and chief of infectious disease at the Kaiser Permanente Medical Center in San Rafael, Calif.

“I was disturbed to find maybe we had a little more confidence in the vaccine than it might deserve,” Witt said.

His research looked at roughly 15,000 children in Marin County in in the San Francisco Bay Area. The sampling included 132 who contracted whooping cough, many of whom were in the 8-to-12 age range."


From http://www.kpbs.org/news/2010/dec/15/whooping-cough-experts-rely-vaccine-companies-mone/:

'An investigation by the Watchdog Institute, an investigative reporting center at San Diego State University, and KPBS, San Diego’s public broadcast affiliate, has found that the two leading global makers of pertussis vaccines, Sanofi Pasteur and GlaxoSmith Kline, have funded expert groups that recommend vaccine policy on the disease to government agencies."
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#12 of 49 Old 05-14-2012, 02:02 PM
 
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Again, so what? The vast majority of those becoming ill simply doesn't mean much, it's the relative risk you have to compare.
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#13 of 49 Old 05-14-2012, 05:10 PM
 
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The statistic that "most people who get infected are fully vaccinated" is completely worthless, a total red herring, and akin to saying "the sky is blue.". It belies a total misunderstanding of statistics and relative risk at best and is intentionally misleading at worst.

Well, as discussed ad nauseum in this thread, scientists employed by pharmaceutical companies found those statistics compelling enough, i.e. far from meaningless.

 

I do appreciate that ProScienceMum posted this article.  It raises a couple of telling issues:

 

Quote:

 

Although no deaths have been reported so far this year, the state has declared an epidemic and public health officials say the numbers are staggering: 1,284 cases through early May, the most in at least three decades and 10 times last year’s total at this time, 128.

 

Good information so far....but then look at this.

 

 

Quote:

The county’s top medical officer, Dr. Howard Leibrand, who is also a full-time emergency room physician, said that in the crushing triage of a combined health crisis and budget crisis, he had gone so far as to urge local physicians to stop testing patients to confirm a whooping cough diagnosis.

If the signs are there, he said — especially a persistent, deep cough and indication of contact with a confirmed victim — doctors should simply treat patients with antibiotics. The pertussis test can cost up to $400 and delay treatment by days. About 14.6 percent of Skagit County residents have no health insurance, according to a state study conducted last year, up from 11.6 percent in 2008.

 

And this:

 

Quote:

But with only two nurses processing the disease reports she sends over to the county, down from five a few years ago, Ms. Neff said she had stopped even trying to ask for confirmation.

“They don’t have time to call and say who’s positive and who’s negative,” she said.

 

So in Skagit County, the part of the state hardest hit by this epidemic, it is impossible to collect accurate data because these cases aren't even laboratory-confirmed.  Which cases were B. Pertussis?  Which have been parapertussis, for which there is no vaccine?  Are these budget cuts affecting other areas of the state?  We have a red flag: Take any cited epidemiologic data with a grain of Morton salt. 

 

As this article rightly points out, there may be many more cases that we don't know about, especially if they were milder and someone just thought they were home with a PITA of a cold.  On the flipside, however, there may be fewer cases if doctors are diagnosing strictly based on personal observation...or perhaps some are underdiagnosing based on personal confidence in the vaccine and the belief that their vaccinted patients couldn't possibly have pertussis.  (The pertussis component of the DTaP vaccine, by way of review, ranges in effectiveness from 59-89%). 

 

 

Quote:

“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.”

 

OK.  This part just makes me want to...to... banghead.gif

 

So let me get this straight.  Here we have a vaccine that may not even work at all, (see post #156)--and we have an opportunity to test for disease strains....or even confirm the presence of B. Pertussis itself so that we can gather accurate data and prescribe interventions accordingly.  But no, let's just keep pushing the vaccine.  If it doesn't work, look at the bright side.  Washington, already strained by an 18% budgetary shortfall, can flush all of that money completely down the toilet, while its Australian cohorts take the sensible and pro-science approach.  It boggles my mind. dizzy.gif   Spending that money on gathering accurate scientific and epidmiologic data, even if it costs more than blanket vaccination programs, would be a MUCH wiser use of resources.  At least then we'd know it isn't wasted.

 

 

So does this article help me make my decision?  No.  I don't count little blurbs in the NYT--in this case, one that lacks some vital and relevant information already brought up in this thread--as a resource.  But the citations I've provided have helped me.

 

To date, given the aforesaid evidence and the manufacturer's own admission that the vaccine isn't proven to stop transmission (from the Adacel package insert.  Sorry.  Can't find it online--you'll have to access a hard copy), I'm 100% unswayed by appeals to cocoon.  My kids are up-to-date on their DTaP doses because pertussis really isn't a disease that I want to monkey with.  But with all of the uncertainities and questions as yet unanswered by science, I do often question that decision.  It's a complicated issue all around.


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What statistics did those scientists use, turquesa? I did not see where it said.
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The pertussis vaccine does work. It has a lower effectiveness than most vaccines, but it does lower your chances of contracting pertussis and passing it on.
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And the lower effectiveness rate makes it even less meaningful to compare counts instead of rates. Saying the majority of people in an outbreak were vaccinated simply doesn't tell us anything we don't already know.
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#17 of 49 Old 05-14-2012, 05:44 PM
 
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What statistics did those scientists use, turquesa? I did not see where it said.

Are you asking me to provide a citation?  winky.gif duck.gif


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sure? I just don't remember that article on cocooning saying "well, most people who got pertussis had the vaccine anyway, so we give up.". As I recall we spent a lot of time discussing how we don't actually know what that decision was based on beyond a "lack of clinical effectiveness."

The important thing, again, is not that there were more people in an outbreak who were vaccinated, it's comparing the rates and looking if there were more people than we EXPECTED who were vaccinated and yet got the disease. Comparing the counts is worthless.
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#19 of 49 Old 05-14-2012, 08:15 PM
 
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Turquesa,

 

As usual, you do not disappoint! Thanks for the info.


 
 
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#20 of 49 Old 05-14-2012, 09:12 PM
 
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Living in WA and having an unvaxxed 3 y/o and another on the way, I have been reading everything out there about the "epidemic".  I put it in quotes because I recently found out that WI has had over 2000 cases of pertussis this year--but their state did not declare it an epidemic so it hasn't been in the news.  I understand why WA did it, they need the emergency funding.  BUT I don't know if the word "epidemic" is correct for the situation.  I did read the NYT article a few days ago when it came out.  I was happy to see there was more mentioned in it than previous articles, most have been repeating the same thing over and over again with different headlines.  So thanks for posting it for others who come here to read.  We need all the info we can get.  But listen to this story....

 

My 3 y/o got a serious respiratory virus with a cough last week.  Since we don't vax and we are concerned about pertussis, I took her immediately to her ped to ask for a culture.  She said that the directive from the DOH is that any suspected case gets immediate abx.  (As mentioned in the article, they aren't necessarily testing everyone.)  I said we were not interested in the abx UNLESS she had a culture confirmed case of pertussis.  She was about to protest (but she wouldn't have forced us, she's a very nice doctor) but I said from a public health standpoint I see her concern and understand it.  I promised to keep DD at home under quarantine until the culture came back.  (I keep her home when she is sick anyway, so it was a non issue for me.)  So she told me I had to go to my local hospital for the swab (and you know how long the waits are there, and also how many other things they get exposed to!)  However, before I had gone in to the appt, I had called all our local labs to see if any did walk in for the pertussis PCR, since I actually thought she might have pertussis.  I found one.  So I told the doctor, "Look, I want to take her to such and such lab....Can you please give me a lab slip?"  She was happy to, but she had no idea there was a walk in testing available in our area until I mentioned it.

 

So anyway, my reason for writing this is most parents would just say "OK" to the abx.  Because it's easier and less issue, especially if they think the only option is to get testing at the hospital and I understand...But!!!!  DD did NOT have either pertussis or parapertussis.  Who knows what it was.  She coughed so hard her lips turned blue and the threw up.  However it only lasted a week.  And the cultures/PCR were negative.  So anyway, my main point is, if we had just taken the abx and gone home, the doctor might probably have reported her to the DOH as having pertussis since she is unvaxxed and had a severe cough....But it would have been a false case.  So my point is that I wonder if the hysteria around the word 'epidemic" might mean that this scenario is being played out all over our state.  It's literally impossible to know.  I'm not doubting there is a huge increase in pertussis cases in our state.  I'm afraid of exposure for my kids (especially the newborn when she comes out), that is for sure.  But I wish they would culture all suspected cases with the PCR method (I had to specially request it, they normally use just the standard nasalpharyngeal swab) instead of trying to cut costs.  Because how can we know for sure what the numbers really are?


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#21 of 49 Old 05-15-2012, 04:32 AM
 
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This is EXACTLY what happened a couple of years ago with the h1n1 debacle. Doctors were told to abandon testing and assume all flu-like illnesses were the dreaded and deadly h1n1, and to report and treat as such, thus artificially inflating both the numbers of reported cases of flu and h1n1, and making it appear that a vaccine was necessary.

In retrospect, h1n1 turned out to be milder than seasonal influenza, the vaccine turned out to be ineffective (a Canadian study actually reported that being inoculated for both seasonal flu and h1n1 INCREASED chances of developing h1n1!), and the vaccine manufacturers were left with millions of doses of surplus flu vaccines that nobody wanted.

So they didn't bother to reformulate the vaccine for the 2011-2012 season, and announced that everyone need to get it again, but it was too late--too many people had figured out the truth, as published by the Cochrane Collaborative:the flu shot simply doesn't work as marketed.

In my opinion, there have been several good things that have come of this:
1) People have FINALLY learned to wash their hands and to keep sick children home from school,
2) People have learned that they can survive the flu, that the fear drummed up by the media is usually worse than the actual flu
3) People have stopped blindly trusting the FDA, the CDC, the pharmaceutical ads in the media, and their doctor's, and have started to educate themselves about their own health.

I wonder if the Cochrane Collaborative will come out with a study on the effectiveness of DTaP.

And isn't it amazing that the doctors don't know that you can go to a lab for pertussis testing rather than the MUCH more expensive ER?

(edited for clarification)
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#22 of 49 Old 05-15-2012, 05:58 AM
 
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And isn't it amazing that the doctors don't know that you can go to a lab for testing rather than the MUCH more expensive ER?

 

Maybe its because I live in an extremely urban area, but anytime we need testing/blood draws/whatever we are sent to a lab. By the doctor. So is everyone else.

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Maybe its because I live in an extremely urban area, but anytime we need testing/blood draws/whatever we are sent to a lab. By the doctor. So is everyone else.

 

Sorry, my post wasn't clear, so I edited it.  I meant that the doctors didn't know that one could go to a lab rather than the ER for pertussis testing.  

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#24 of 49 Old 05-15-2012, 07:05 AM
 
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I've been sent to the hospital several times for tests that didn't involve the ER. I just went directly to the appropriate department/lab.

 

nukuspot, were you told you had to go to the ER? If so, I agree that would be pretty ridiculous.

 

edited to fix typo

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#25 of 49 Old 05-15-2012, 07:24 AM
 
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Two years ago, my best friend was sent by her doctor to the ER for an h1n1 test. Not to the lab, but to the ER.

 

On the other hand, that same month, my son's pediatrician did an h1n1 test in the office when he was seen for a UTI.

 

This was before the directive came down to assume all flu-like symptoms were h1n1.

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The plural of anecdote is not data.
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#27 of 49 Old 05-15-2012, 07:49 AM
 
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No not to the ER, to an in hospital lab. But the waiting room is full of very sick people (it's shared with all parts of the main hospital) and there is a wait involved. It's much easier and IMO safer as far as getting sick from someone (or likewise transmitting pertussis if my DD actually did have it) to go to the ER. We live in the state Capitol, it's crazy to me that even in an epidemic situation the only choices for getting tested are the hospital or one lab (and only in normal business hours of course.)

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#28 of 49 Old 05-15-2012, 08:03 AM
 
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      Quote:

Originally Posted by nukuspot View Post

It's much easier and IMO safer as far as getting sick from someone (or likewise transmitting pertussis if my DD actually did have it) to go to the ER.

 

Safer and easier to go to the ER for a lab test?  I guess this must really depend on the hospital. That would not be the case here.

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#29 of 49 Old 05-15-2012, 08:31 AM
 
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Oops I didn't mean go to the ER I meant easier to go to the lab.

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#30 of 49 Old 05-15-2012, 08:33 AM
 
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And not the hospital lab, the private lab. Not explaining myself well, typing on a phone. Sorry!

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