Who’s to blame for the whooping cough outbreak?

Julia Bellus answers reader questions on vaccines

by Julia Belluz

You asked, Science-ish answered: This is the second installment of a Science-ish series on vaccines inspired by readers’ questions. Listen to part one, a Science-ish podcast, here.

For a long time, the anti-vaccine lobby got away with a hell of a lot in the press. We gave a quack-based minority equal air-time with the science-based majority. Just read some of what’s been written on the media’s role in perpetuating theories about the supposed MMR-autism link.

Today, it seems with every outbreak of a vaccine-preventable disease, the blame rests squarely—or “disproportionately“—on vaccine deniers who ought to know better. Take whooping cough, the bacterial infection of the lungs that causes a violent cough-vomit combo and sounds like (be prepared for it) this. In recent years, epidemiologists have been tracking a spate of worrying outbreaks, and the incidence of whooping cough is on the rise in Canada and elsewhere.

This wasn’t always the case. After the vaccine was introduced in the 1940s, the incidence of pertussis dropped from epidemic proportions to almost zero. But now the 100-day cough is back again, and alternative-medicine types, especially the ones who consider oregano oil ”the natural way” to stave it off, are being fingered.

As much as vaccine deniers may be insufferable to the Science-ish audience, do they really deserve all the blame?

Science-ish called Dr. Scott Halperin, an internationally regarded pertussis expert based at Dalhousie University in Nova Scotia. “Microorganisms are living organisms,” he said over the phone. “They are evolving and so are we. When an outbreak occurs, it’s usually multiple different factors that contribute to it.”

That’s the case with whooping cough, he explained. For a long time, people thought immunity from both the disease and the vaccine would last a lifetime. Science evolves, and researchers now know that’s not the case. In fact, immunity from the vaccine isn’t even lasting for as long as was originally anticipated. “People hoped it would last 10 years,” said Dr. Halperin, “and it’s lasting about six.”

According to a September New England Journal of Medicine study, involving several hundred kids in California, protection against whooping cough wore off during the five years following the fifth dose of the vaccine in childhood. That means that by adolescence, some people will be susceptible to getting the disease again.

Another contributor to the outbreaks: The kind of whooping cough shots we use now—called the diptheria-tetanus-acellular pertussis vaccine—are safer but also weaker than the previous vaccines. So adults are supposed to get a booster. But many aren’t bothering, said Dr. Halperin. “The estimated uptake of the vaccine is only about five to seven per cent in adults.”

This means there’s an unboostered at-risk adult population that’s partly to blame for spreading the bacteria around. As this article in the PLoS blogs network explains, the adult epidemic is made worse by the fact whooping cough often masquerades as a regular cough in grown-ups, partly because of residual immunity from childhood. There are fewer complications from pertussis in adults, and side-effects are milder—but the cough is still very contagious, and spreadable to infants and children who can die from the illness.

Until an improved whooping cough vaccine is approved and recommendations are changed to reflect the latest science, Dr. Halperin suggested keeping up to date with your immunizations. And of course, not to become a vaccine denialist. “We certainly can’t blame all of what’s going on with whooping cough on people who are vaccine refusers,” said Dr. Halperin, “but they are not making the situation any better.”

Science-ish
is a joint project of
Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the associate editor at the Medical Post. Got a tip? Seen something that’s Science-ish? Message her at julia.belluz@medicalpost.rogers.com or on Twitter @juliaoftoronto

 




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Who’s to blame for the whooping cough outbreak?

  1. Whose what? Or did you mean who’s, short for who is?

  2. Any other consumer product with a 90% failure rate would be laughed right out of existence but not if its a worthless and dangerous vaccine. Then we have to put up with articles written by Bimbos like this. Julia, you couldn’t differentiate legitimate science from medical industry BS if it bit you in the behind.

    • Oh, Bob…you’re so cute when you’re off your meds.

    • Smallpox eradication… 100%; except for the US and Russia who are keeping stocks out of paranoia.
      Any science you’d like to introduce to counter this claim?

    • Please don’t call people ‘Bimbo’, it’s name calling.
      It’s rude and it makes you look like an @sshat.

  3. When I was a boy (late 1960′S) I had long and persistent bouts of coughing with the characteristic long whoop for breath at the end of the coughin. Lasted a few months and recurred slightly for the next year when I ate ice cream or breathed in a lot of winter air. Doctor diagnosed para-pertussis, which is apparently what they call the version of whooping cough that you get after having had the DPT shot.
    The point of my anecdote is that, since we’re trying to find who is to blame, it might not be the lack of booster shots, but the effectiveness of the oriingla shot itself, Perhaps the vaccine is poorly stored or badly applied or there are bad batches produced? Why would we assume 100% effectiveness of any program, let alone one that requires the widescale manufacture, distribution and administration? Seems ot me there are a few data points missing in the story line.

    • tobyornotoby, nobody ever said that any vaccine was 100% effective. Yes, there will be some people who get pertussis even having had the vaccine, but it’s the same logic that applies to wearing a helmet, you take the precautions you can to give yourselves and your children the best fighting chance.

      • Yes they were. My point is the process then (not sure about now) assumed the success of the immunization even to the point that when it obviously didn’t work, rather than accepting that, medical professionals made a new classification called “para pertussis” and then went around claiming that pertussis was all but wiped out. That’s not exactly rigourous scientifically, so all I’m saying is we should doubt the immunization is completely effecteive even at 6 years, and attribute at least some of the blame for the resurgence on that.

        • Bordatella parapertussis is a close relative of the Bordatella pertussis bacterium. The vaccine is designed to protect from the pertussis species (the usual causative agent of whooping cough, or “pertussis”), with some crossover (weaker) protection from the parapertussis species, which is less common and /usually/ causes less severe disease. It’s not what we call pertussis in vaccinated people, it’s a different species of the same genus of bacteria.

          We never did assume 100% effectiveness of the vaccine, but as we learned with smallpox, if we can protect enough people around someone who is infected, they never get the chance to spread their infection, and eventually we can eliminate the disease-causing organism. This appeared to happen with whooping cough, but as fewer people got vaccinated, immunity waned in older adults, and we switched to a vaccine with fewer side effects (DTaP instead of DTP) that was unfortunately less effective, we now have an opening for pertussis to resurface in a meaningful way.

  4. What a crock of bull. Good health starts with real food/diet and exercise. NOT NEEDLES

    • Yeah alright and that healthy diet and exercise really helped stave off the smallpox didn’t it? Oh that’s right it didn’t, science and vaccination did.
      Actual facts and the history of disease prevention mean nothing to you do they?

    • Oh, you’ve used all capitals. Fair point then. IDIOT.

    • I presume your childen wear helmets when they ride a bike, and that you and your family wear seatbelts when you are in a car? It’s the same with vaccines. Perhaps they are not 100% effective, but they give the best shot. Luckily, this generation doesn’t know the tragedy of polio, smallpox, congenital defects from Rubella, that’s due to vaccines.

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