Pertussis...It's not just WA state! 2012 numbers as of 2 days ago - Mothering Forums
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#1 of 51 Old 05-20-2012, 06:38 PM - Thread Starter
 
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http://www.examiner.com/article/new-york-whooping-cough-cases-near-1000

 

I was very surprised to read this article.  From the news it seems like it is just WA state, seems many more states have pertussis now and even some have more or almost equal to here.  I guess WA is just in the news because they were the ones who declared it an epidemic first.  Just shows you how you can't always trust the news to be up to date...

 

Take that the "it's happening in WA because we have one of the highest exemption rates in the country" media drivel.  It's just a nationwide high season for it...


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#2 of 51 Old 05-21-2012, 06:55 AM
 
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Thanks for posting the statistics. Rates up 51% on the same time last year - scary.

 

Now I'm worried for friends living in the Ithaca area who have both a disabled child and a newborn. 65 cases in that small area sounds a lot. 


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#3 of 51 Old 05-21-2012, 07:31 AM
 
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Unfortunately vaccination rates for dtap are down all over the country. Add to that the relatively low effectiveness for dtap and the fact that natural infection can give immunity for as lttle as four years and herd immunity Is compromised very quickly.
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#4 of 51 Old 05-21-2012, 08:34 AM
 
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Rachel - this is one of those vaccines which adults are recommended to get a booster right? I'm surprised this never came up when my kids were little..... Next time I'm at the Doctor I must remember to ask if I should be getting a booster. Mind you when I applied for my US Greencard I had to have all sorts of checks on my immunization status (and a chest X-ray to prove I didn't have TB since as I was vaccinated against it I had a positive skin test!), so perhaps I got a booster then. I don't remember.


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#5 of 51 Old 05-21-2012, 08:45 AM
 
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Prosciencemum: My husband and I both got a pertussis booster with our greencard application (and I had another MMR vax since the record from my childhood vax was MIA, and the date on record when I recieved it again when I first moved to the US for grad school wasn't sufficiently clear).  The message we got in terms of vaccine status was "if in doubt, we'll revaccinate/update".
 


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#6 of 51 Old 05-21-2012, 09:05 AM
 
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It's only been in the las ten years or so we realized adults needed a boosters, so depending on how long ago I was it might not have been the recommendation or it might not have been very widespread, yet. When I was recently pregnant the recommendation was if I hadn't had a tetanus shot in the last few years I should get a booster. If I had it was probably in the tetanus booster.
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#7 of 51 Old 05-21-2012, 10:15 AM - Thread Starter
 
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Tdap for adults was only introduced in 2005.  My DH got his GC in 2003, and was revaxxed for many things, but pertussis was not one of them.  Most adults do not know about the adult Tdap because it's relatively new as far as vaccines for adults go.  He just went to the doctor and requested a Tdap last month when we started hearing about pertussis in our area.  She did not offer it to him outright. 

 

I don't believe for a moment that the resurgence has much to do with declining DTaP rates in children.  It's a cyclic disease with an ineffective vaccine which wears off quickly.  This is a high point on a cycle.  The fact that it is appearing all over the country (which has a nationwide vaccine compliance rate of 99% in children) shows it is not just popping up in communities and pockets where there are low vax rates.

 

Interestingly, the UK does not have an adult booster for pertussis.  One cannot get a Tdap equivalent there.  Pertussis vaccine is only given up to the age of 7.  I know this because my in laws are trying hard to get a booster before they come meet the new baby in the fall and they are failing miserably.  But as of yet, no pertussis is sweeping the UK because of all the unvaxxed older children and adults...

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#8 of 51 Old 05-21-2012, 10:38 AM
 
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And yet pertussis rates are highly correlated with vaccine rates.
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Originally Posted by Rrrrrachel View Post

And yet pertussis rates are highly correlated with vaccine rates.

 

Correlation does not equal causation.

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#10 of 51 Old 05-21-2012, 11:54 AM - Thread Starter
 
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I have yet to see a recent, reputable source tying pertussis rates with vax rates. Since (looking at the pertussis map linked in that article) almost 3/4 of the states are having a substantial rise in cases and the CDC says 99% of kids are fully vaxxed...It doesn't look that way to me. I am talking about DTaP here for kids, not Tdap, of which the uptake rate in adults and older kids is only 10% but rising with the pertussis cases. (CDC 2012)

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#11 of 51 Old 05-21-2012, 11:57 AM - Thread Starter
 
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And to be clear I am not a denier of the sacred cow of "herd immunity.". I do believe it exists for many VPDs. But the reality shows pertussis is not one of them.

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#12 of 51 Old 05-21-2012, 12:23 PM
 
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Tdap for adults was only introduced in 2005.  

TDaP may have been introduced in 2005--but before that, they used DPT (the whole-cell pertussis version).

 

I was given it in 1987.  I was told it was a "tetanus booster."   

 

Last I checked, they are still routinely giving either TDaP or DTaP as a "tetanus booster." 

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#13 of 51 Old 05-21-2012, 12:24 PM
 
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This is an example of a study talking about how pertussis rates and lower vaccination rates are correlated.  I have read it a few different places, but you know how that goes, you read something while you're looking for something else and then you forget where it was.

 

http://www.ncbi.nlm.nih.gov/pubmed?term=Geographic%20clustering%20of%20nonmedical%20exemptions%20to%20school%20immunization%20requirements%20and%20associations%20with%20geographic%20clustering%20%20of%20pertussis.%20O

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#15 of 51 Old 05-21-2012, 01:25 PM
 
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Could both of you be right? I mean it seems like there could be clusters of higher rates of pertussis where there are lower vaccination rates but that pertussis could be on the rise in general as well.

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#16 of 51 Old 05-21-2012, 01:29 PM
 
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That's what I think. I don't think lower rates o vaccination are the only factor but I'm not prepared to dismiss them as a major player.
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#17 of 51 Old 05-21-2012, 01:38 PM
 
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The NHS website (UK National Health Service) claims that. 

 

 

 

Quote:

The introduction of a vaccination programme during the 1950s and the introduction of a pre-school booster jab in 2001 means the annual number of cases of whooping cough in the UK is usually very low.

However, the Health Protection Agency (HPA) reported a surge in cases in 2011.  A total of 1,040 laboratory confirmed cases were reported in 2011, more than double the 421 cases reported in 2010.

 

In fact in old articles online you can find claims that Whooping Cough has been irradicated in the UK thanks to vaccinations.

 

There is a Guardian article from earlier this year saying that 2012 has seen a large caseload in the UK too - already 665 by April 2012: http://www.guardian.co.uk/society/2012/apr/13/whooping-cough-cases-rise-england

 

Stating there is no increase in cases of whooping cough here in the UK is clearly incorrect. 

 

I found some old UK articles from 2008 about vaccinating the parents of newborns, but that has not yet been implemented here. For example this one from the BBC in November 2008: www.bbc.co.uk/2/hi/health/7752869.stm

 

This states that

 

 

 

Quote:

Several countries have now introduced booster doses for adolescents, including the US and Australia.

France and Germany recommend a targeted booster for parents and healthcare workers in close contact with young children.

but also that

 

 

 

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A Department of Health spokesperson said the Joint Committee for Vaccination and Immunisation (JCVI) looked last year [2007] at the possibility of introducing a booster vaccination against whooping cough for adolescents and parents of young babies.

However, it decided not to recommend any changes to the current whooping cough immunisation schedule but to continue monitoring the situation carefully.

"Recent statistics do not indicate a rise in the number of Whooping cough cases.

 

 This in 2008 though. I wonder if they're thinking about it now....

 

 Anyway it does seem that it would be tricky for an adult to get a booster in the UK on the NHS. However - for nukuspot I'm sure your parents in-law should be able to get a booster as a travel vaccination (paid). For example this one (http://www.globetrotterstravelclinics.com/vaccine_price.htm) lists Diphtheria/Tetanus/Polio for £30.  

 

 

 

 


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#18 of 51 Old 05-21-2012, 02:43 PM
 
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Unfortunately vaccination rates for dtap are down all over the country.

 

??????  Huh????  According to CDC data   (the most recently available figures), vaccination rates are, overall, on the upswing.  What figures are you looking at?  Or are people consenting to more vaccines but just not DTaP?

 

The state-by-state exemption rates are pretty low, overall, and not even indicative of who is forgoing the DTaP vaccine.  (Some parents may seek exemptions only from certain diseases, e.g. varicella, Hep B, and Hep A). 

 

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Originally Posted by Rrrrrachel View Post

This is an example of a study talking about how pertussis rates and lower vaccination rates are correlated.  I have read it a few different places, but you know how that goes, you read something while you're looking for something else and then you forget where it was.

 

http://www.ncbi.nlm.nih.gov/pubmed?term=Geographic%20clustering%20of%20nonmedical%20exemptions%20to%20school%20immunization%20requirements%20and%20associations%20with%20geographic%20clustering%20%20of%20pertussis.%20O

Well, it focuses on one case in Michigan...hardly supporting your statement in Post 8 that "pertussis rates are highly correlated with vaccine rates." 

 

Plenty of undisputed examples were provided to you in Post #163 of this thread indicating quite the contrary. 

 

 

This one is problematic for making your case because it accounts for pertussis cases when DTP was still in use, which despite its egregious reputation for side effects, was likely was a stronger vaccine than the current DTaP.  Also, the studies that I referenced in that same thread that I just linked were conducted in the late 1990s, when we first saw evidence of vaccine-resistent pertussis.  The study that you're referencing accounts for cases before that time. 

 

Also, do a search on Daniel Salmon and Merck.  While that doesn't necessarily invalidate a study, it's important for the public to be aware of conflicts of interest.

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#19 of 51 Old 05-21-2012, 02:57 PM
 
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It was just an example, not an exhaustive list.

Vaccine coverage isn't uniform. It's possible for overall rates to go up and have more pockets of unvaccinated children. It's my understanding that across the country there are more and more pockets of unvaccinated people like this, particularly with dtap.
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#20 of 51 Old 05-21-2012, 03:20 PM - Thread Starter
 
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The NHS website (UK National Health Service) claims that. 

 

 

 

 

In fact in old articles online you can find claims that Whooping Cough has been irradicated in the UK thanks to vaccinations.

 

There is a Guardian article from earlier this year saying that 2012 has seen a large caseload in the UK too - already 665 by April 2012: http://www.guardian.co.uk/society/2012/apr/13/whooping-cough-cases-rise-england

 

Stating there is no increase in cases of whooping cough here in the UK is clearly incorrect. 

 

I found some old UK articles from 2008 about vaccinating the parents of newborns, but that has not yet been implemented here. For example this one from the BBC in November 2008: www.bbc.co.uk/2/hi/health/7752869.stm

 

This states that

 

 

 

but also that

 

 

 

 

 This in 2008 though. I wonder if they're thinking about it now....

 

 Anyway it does seem that it would be tricky for an adult to get a booster in the UK on the NHS. However - for nukuspot I'm sure your parents in-law should be able to get a booster as a travel vaccination (paid). For example this one (http://www.globetrotterstravelclinics.com/vaccine_price.htm) lists Diphtheria/Tetanus/Polio for £30.  

 

 

 

 


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!!!


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#21 of 51 Old 05-21-2012, 03:26 PM - Thread Starter
 
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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.


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#22 of 51 Old 05-21-2012, 03:31 PM
 
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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.
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#23 of 51 Old 05-21-2012, 03:34 PM - Thread Starter
 
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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.


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#24 of 51 Old 05-21-2012, 03:36 PM - Thread Starter
 
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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.


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#25 of 51 Old 05-21-2012, 03:43 PM
 
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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.
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#26 of 51 Old 05-21-2012, 03:46 PM
 
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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.
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#27 of 51 Old 05-21-2012, 03:48 PM - Thread Starter
 
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Yes, back to the original topic.  "Pertussis, it's not just in WA state."


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#28 of 51 Old 05-21-2012, 03:52 PM
 
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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.
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#29 of 51 Old 05-21-2012, 05:41 PM
 
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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.....

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#30 of 51 Old 05-22-2012, 01:26 AM
 
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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. 


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