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Discussion Starter · #1 · (Edited)
We have briefly discussed whether it might be more beneficial to recommend the old pertussis vaccine over the new one as issues with efficacy and waning immunity have come to light.

Well, now there is a new study looking into the topic and I thought it might be interesting for us to discuss this point again. Is it time to bring the old vaccine back as an option?

Newer isn't always better — some researchers are proposing to bring back an older version of the whooping cough vaccine, because multiple studies show that today's version doesn't protect as well as the earlier kind.

The older, whole-cell pertussis vaccine is linked with a higher rate of side effects, such as fever, than is the newer version. But because improved vaccines against whooping cough are likely years away, "in the interim, switching to the combined strategy is an effective option for reducing the disease and mortality" from whooping cough the researchers wrote in their findings, published today (March 28) in the journal JAMA Pediatrics. [5 Dangerous Vaccine Myths]

The current vaccine schedule calls for five doses of the acellular vaccine, with one dose occurring at each of the following times: ages 2 to 4 months, 4 to 6 months, 6 to 8 months, 18 to 24 months, and 4 to 5 years. In the new study, researchers compared using that schedule with a "combined" vaccine strategy, of giving an initial dose of the whole-cell pertussis vaccine followed by four doses of the acellular pertussis vaccine.

The combined strategy would reduce symptomatic whooping cough cases by 95 percent, and would reduce cases in infants by 96 percent, compared with the current strategy, the models predicted. With the combined strategy, there would also be a 96 percent decrease in hospitalizations from whooping cough and a 95 percent decrease in infant deaths from the disease, compared with the acellular strategy.

However, the combined strategy would have higher rates of vaccine side effects: There would be about 10 more cases of fever for every 100,000 vaccinations, and seven more cases of seizures for every 10 million vaccinations, compared with the acellular vaccine strategy.

Overall, the combined strategy would lead to a 96 percent decrease in hospitalizations due to either whooping cough or vaccine-related side effects, the study found.

http://www.livescience.com/54210-whooping-cough-old-vaccine.html
 

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I support efforts toward developing a new vaccine, but not toward reverting back to the old one. Doing the latter would expose children to a higher level of medical risk-taking, per this article's admission, in a legal climate that makes it increasingly harder to opt out. At this time, there is unfortunately no new acellular vaccine in development.
 

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Discussion Starter · #5 · (Edited)
I support efforts toward developing a new vaccine, but not toward reverting back to the old one. Doing the latter would expose children to a higher level of medical risk-taking, per this article's admission, in a legal climate that makes it increasingly harder to opt out. At this time, there is unfortunately no new acellular vaccine in development.
The article points out that the study showed the benefits outweigh the risks. I'd likely get it if it was available, it was the vaccine I and everyone else I knew growing up got. It works a lot better and no one I knew had any issues or side effects. A lot of the problems that were thought to be caused by the vaccine were shown with later studies to not actually be associated. Pertussis in a baby scares me a lot more than a febrile seizure or fever.
 

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Until there's more choice, parents should not have to shoulder more risk.

If the vaccine were an option for parents, that would be one thing. But at least in the U.S., most medical practices are on the Vaccines for Children program, which doesn't entail any consumer choice.
 

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Personally, if they were to switch to the whole cell again that would cause me to delay even longer. As it is LO hasn't had his dTap yet because the "smallest" vax they will allow him for dTap is actually dTap-HepB-IPV-HIB but he'll be getting it soon. If it were whole cell I wouldn't even be considering it yet.


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Discussion Starter · #8 ·
Until there's more choice, parents should not have to shoulder more risk.

If the vaccine were an option for parents, that would be one thing. But at least in the U.S., most medical practices are on the Vaccines for Children program, which doesn't entail any consumer choice.
I did say option in my OP. Right now, I don't think a parent could get this vaccine even if they wanted to.
 

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I personally would have no issue with it being an option. My concern would be that parents wouldn't be really given the option of dTap and doctors would favour the dTwp. I'm worried parents would be bullied into the whole cell instead of acellular which isn't fair.


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I did say option in my OP.
I think you were asked because you didn't.

We have briefly discussed whether it might be more beneficial to recommend the old pertussis vaccine over the new one as issues with efficacy and waning immunity have come to light.

Well, now there is a new study looking into the topic and I thought it might be interesting for us to discuss this point again. Is it time to bring the old vaccine back as an option?
Where is your option on this? I can't find it on the OP.

Please do not just post a link or article without adding your own thoughts regarding the information you are sharing.
http://www.mothering.com/forum/47-v...eferencing-articles-studies-another-site.html
 

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I would think their recommendation is backwards. My understanding is aP works fine in the short term and loses effectiveness very quickly. Wouldn't it make more sense and be safer to do aP first and wP later in life when the risk of febrile seizures is lower?
 
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I was under the impression those "what do you think" questions were no more as stand alone but we were to add personal thoughts, as I quoted.


I agree that was missed in the OP, I was just pointing out that her statement that her OP did say option was correct. Someone asked her opinion, but that was separate from her pointing out she asked about it being an option, not a complete replacement for dTap based vaccines.
 
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I agree that was missed in the OP, I was just pointing out that her statement that her OP did say option was correct. Someone asked her opinion, but that was separate from her pointing out she asked about it being an option, not a complete replacement for dTap based vaccines.
She was also asked up thread by @EMRguy as to why it was posted.

I find threads disingenuous to only ask question without supplying the reason you are doing so. Add to a discussion if you know the OP reasoning upfront is beneficial-IMO
 

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Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP) 1997 http://www.cdc.gov/mmwr/preview/mmwrhtml/00048610.htm

Vaccine Preference

DTaP vaccines are efficacious when administered to infants as the primary series (i.e., doses 1-3). In addition, local reactions, fever, and other systemic events occur substantially less often after DTaP administration than after administration of whole-cell DTP. Therefore, DTaP vaccines are recommended for all five doses in the vaccination schedule. For children who have started the vaccination series with one, two, three, or four doses of whole-cell DTP, DTaP is also recommended for all remaining doses in the schedule. During the period of transition from use of whole-cell DTP to DTaP, whole-cell DTP is an acceptable alternative to DTaP for any of the five doses. For the first four doses, whole-cell DTP combined with Hib vaccine (DTP-Hib vaccine) is an acceptable alternative to DTaP and Hib vaccine administered at separate sites.
Data from the Vaccine Adverse Event Reporting System (VAERS)@@@ were used to compare rates of fever, seizures, and hospitalizations among children who, having had greater than or equal to 3 previous doses of whole-cell DTP, were administered either DTaP or whole-cell DTP vaccines for the fourth or fifth doses (46). During 1991-1993, approximately 5 million doses of DTaP (distributed by Connaught Laboratories, Inc., or Wyeth-Lederle Vaccines and Pediatrics) and 27 million doses of whole-cell DTP were distributed for use among children aged 15 months-6 years. Adverse events were reported significantly less commonly among the children who received DTaP.
Note that doses distributed is not the same as doses administered.

That seems to contradict what Teacozy stated up thread.

Of interest:
If any of the following events occurs within the specified period after administration of either whole-cell DTP or DTaP, vaccine providers and parents should evaluate the risks and benefits of administering subsequent doses of a pertussis-containing vaccine:

Temperature of greater than or equal to 105 F (greater than or equal to 40.5 C) within 48 hours, not attributable to another identifiable cause.

Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours.

Persistent crying lasting greater than or equal to 3 hours, occurring within 48 hours.

Convulsions with or without fever, occurring within 3 days.
And yet today persistent crying is said to be "normal". I would hope that if anyone's partner had a jab and cried for three hours straight- particularly the high pitched crying that these babies do -that they would seek medical help for their partner. No different for babies. Don't buy into the purple crying BS. :frown:
 

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I do think it should be an option for parents who want it but I don't think I would personally choose it. I'm interested to see what they come up with. I also wonder if they would separate the pertussis from the DT or keep the DTaP in the future. I wish they had more monovalent vaccines in general.

Also, Teacozy says in her first sentence that the reason she's posting is because it's been discussed before and new info has come up.
 

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Discussion Starter · #19 · (Edited)
The new vaccine is associated with an increase in febrile seizures, fever, and maybe high pitch crying (no evidence that this causes any harm) than the old vaccine, but not with any brain damage or seizure disorders and there is not an increased risk of allergic reactions, either. We know the old vaccine has more side effects - but it is also MUCH more effective at preventing pertussis. The study showed that the benefit of better protection against pertussis outweighed the additional risks of the vaccine.

Compare that to the risks of pertussis in infants: (http://www.cdc.gov/pertussis/clinical/complications.html)

In infants younger than 12 months of age who get pertussis, about half are hospitalized. Hospitalization is most common in infants younger than 6 months of age. Of those infants who are hospitalized with pertussis approximately:

61% will have apnea
23% get pneumonia
1.1% will have seizures
1% will die
0.3% will have encephalopathy (as a result of hypoxia from coughing or possibly from toxin)
Other complications can include anorexia, dehydration, difficulty sleeping, epistaxis, hernias, otitis media, and urinary incontinence. More severe complications can include refractory pulmonary hypertension, pneumothorax, rectal prolapse, and subdural hematomas.
There is a good post about this called "A Shot In The Dark Revisisted" by Steven Novella on sciencebasedmedicine about research looking to this issue. For example, this study from 2008:

Comparisons done in children less then 2-years-old show in general about twice as high incidence of adverse effects following the whole-cell than the acellular vaccine. The biggest rate of proportions (RR = 4,75) was observed for high pitch cry. There was no significant difference in incidence of the most severe reactions, including encephalopathy and nonfebrile seizures, and there was no significant difference in allergic reactions.
Novella notes:

So while there were more minor reactions to DTwP, there was no increase in seizures or encephalopathy compared to DTaP, which supports the conclusion that DTwP does not increase the risk of these neurological events. However, a Canadian study found a decrease in hospital admissions for febrile seizures following the transition to DTaP, suggesting that DTwP did increase the risk of febrile seizures. It should be noted, however, that febrile seizures do not generally increase the risk of developing epilepsy or permanent neurological damage.

The DTwP story is a fairly typical one in the world of medicine. Anecdotal reports indicated a possible adverse reaction to the whole-cell pertussis vaccine. Researchers therefore looked at the question in various ways and eventually concluded that no significant signal or pattern could be detected. In short, there does appear to be an increased incidence of adverse events, such as irritability and maybe even febrile seizures, but no evidence of long term neurological harm. Never-the-less, a newer safer version of the vaccine, the acellular pertussis vaccine, became available and was adopted because it was probably safer. Even still researchers continue to drill down into the question of pertussis vaccine safety.

It is not possible to ever prove zero risk from any medical intervention. The data will always be limited. But we can demonstrate that the risk must be below certain upper limits, and that benefits outweigh risks – that net outcomes are improved with the intervention.
https://www.sciencebasedmedicine.org/a-shot-in-the-dark-revisited/
 

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I do think it should be an option for parents who want it but I don't think I would personally choose it. I'm interested to see what they come up with. I also wonder if they would separate the pertussis from the DT or keep the DTaP in the future. I wish they had more monovalent vaccines in general.

Also, Teacozy says in her first sentence that the reason she's posting is because it's been discussed before and new info has come up.
I highly doubt an option for this or any other vaccines would be offered in most cases. The numerous vaccines that people can not get shows there is little desire to do this. Places did not stock enough flu mist resulting in needing to give shots, lack of children's flu shots for CA was an issue this past year, the HPV vaccines, many place will not stock more than one of any type vaccines. Besides there is none for this anyway.

As to the bold and per the rules, that's not personal. I still have no clue why it was posted, and I was not the only one here to ask.
 
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