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Aug 20 2012

Anti-vaxers kill another child

So North Carolina is reporting their first death (of the year, I presume) from pertussis, or whooping cough. A 2-month-old infant has died of the disease.

Whooping cough is highly contagious and spread usually by coughing or sneezing in close contact. It can be serious at any age, but it is life-threatening in newborns and infants who are too young to be fully vaccinated, state health officials said. Many infants who get whooping cough are infected by caregivers who may not know they have the disease.

This is a kid who was too young to have yet obtained the full range of vaccines, and was dependent on herd immunity…and someone carrying the disease infected them, and ultimately killed them. It’s remarkable that deaths from pertussis are now so rare that one of them will make the news—but the way we’ve made the disease rare is by preventive vaccinations. Every person who neglects to vaccinate is contributing to a deadly disease renaissance.

75 comments

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  1. 1
    Alexandra (née Audley)

    This is a kid who was too young to have yet obtained the full range of vaccines, and was dependent on herd immunity…and someone carrying the disease infected them, and ultimately killed them.

    This scares the ever lovin’ shit out of me. Not only am I worried about DarkFetus, but I am not fully vaccinated myself (due to medical reasons).

    It seems like a recipe for disaster (and get yer goddamn boosters, people!)

  2. 2
    skeptifem

    I would urge people to ask their doctor if they are current on their pertussis shot next time they go in. Public health departments can help people who are low/no income who need vaccination as well. I had a booster a couple of years ago, I got it specifically because of outbreaks in my area (and my working with patients directly, of course). I wouldn’t have stayed protected if I had not inquired about it specifically…

  3. 3
    randy

    This exact same scenario was played out two months ago here in Alberta. A child too young to be vaccinated for pertussis died at Calgary’s Alberta Children’s Hospital from complications.

    I have my Tdap, and everyone should be up on theirs.

  4. 4
    kariokie

    I’m constantly aruging with my husbands family, they don’t vaccinate and nothing I say will chwnge their minds. They are creationist-stubborn and needless to say, they will not becoming in contact with my son when he is born; its really unfortunate.

  5. 5
    daved

    I am strongly pro-vax, but it’s quite possible that the infant picked up the pertussis from an unvaccinated adult. Many adults don’t get pertussis boosters, and it’s also starting to look as though the recommended interval for adult pertussis boosters is too long.

    I’ve had mine, and I’d like to see everyone who *can* be vaccinated, get all their shots. However, it is *possible* that this wasn’t due to the anti-vaxers being in the picture. Unless we know where the infant contracted the disease, which we probably don’t. As the article points out, many adults who are infected don’t know it.

  6. 6
    Beatrice, an amateur cynic looking for a happy thought

    daved,

    Maybe the cavalier attitude towards getting boosters is in part due to anti-vaxers’ campaign.

    Or maybe it’s just laziness.

  7. 7
    garnetstar

    My sister, a pediatrician, has had infants under her care die of pertussis. Unfortunately, in almost every case it turned out that they’d gotten it from an older sibling who could have been vaccinated, but wasn’t. I hope that didn’t happen here.

    Any quotes from the parents expressing gratitude for how nationwide rampant medical lunacy helped their kid? Or perhaps just thanking God for his goodness.

  8. 8
    macrophage

    To echo what Daved said, even if the entirety of the US that can get vaccinated does, it’s still possible to transmit or get pertussis. Vaccination has reduced the likelihood, but hasn’t completely wiped out the possibility. Pertussis is horribly contagious.

    For some strange reason the CDC is not pushing adults to get boosters. Neither the DTP nor the DTaP offers lifelong protection.

    And, yes, I’m also about as pro-vaxx as you can be.

  9. 9
    Blueaussi

    David,

    If it was an adult, how and to whom was the adult exposed?

  10. 10
    Curt Cameron

    I’m also strongly pro-vax, but I’ve read that the recent uptick in pertussis cases on the West coast is not really attributable to the anti-vax movement, because adults who were immunized as children need to be re-vaccinated, especially if they care for infants or are around them.

  11. 11
    Vicki, duly vaccinated tool of the feminist conspiracy

    If you live in New York City and have a bit of time, the city Department of Health will be happy to vaccinate you for free. In fact, when I went in for something else they asked whether I wanted a DTaP booster (that covers pertussis, diphtheria, and tetanus). There are clinics in Brooklyn, Queens, and the Bronx (see http://www.nyc.gov for locations and hours).

    They offer a long list of vaccinations, including all the standard childhood vaccines as well as hepatitis A and B. The main things not available are flu and things that are recommended only for travelers outside the United States, such as yellow fever.

    I waited less than half an hour for each of my hepatitis B shots, but you would need to have some free time during the business day.

  12. 12
    Crissa

    I wonder how long it incubates in an adult?

    Anyhow, my doctor recently recommended tdap for everyone as their tetanus expires. Even I got it, and I almost always have a seizure from having an injection. This last time I still had a seizure, but I was in pretty good control the whole time, which was good. Still horribly unpleasant, tho, so we skip flu shots.

  13. 13
    Blueaussi

    From the CDC _Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for Use of Tdap Among Health-Care Personnel_

    “1) adults aged 19–64 years should receive a single dose of Tdap to replace tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their last dose of Td >10 years earlier and they have not previously received Tdap;”

    So, the CDC might not be pushing it, but they’re certainly recommending it.

  14. 14
    Arkady

    Question from a european who barely understands the US healthcare system; how exactly are vaccines covered under the US system? Could any of the drop in vaccination rates be due to a lack of insurance coverage, as well as the anti-vax bullshit?

    Hell, I got my last vaccine booster when I was seeing the nurse at the GPs for a Pill-refill. I mentioned off-hand that I work in a lab that handles polio, and the nurse got an ok from a doctor in another room, got the vaccine out the fridge and gave me a DPT booster then and there.

  15. 15
    macrophage

    Arkady, Some of it might be due to lack of coverage, or people simply not knowing what they need and what is covered by the healthcare they already have.

    I’m told vaccinations will be available without copays with the ACA and that they’re already available via medicare/medicaid. I’m not sure if this involves all vaccinations, though. I was recently quoted $300 for the Hepatitis course, which my employee agreed to pay instead. And I know the local pharmacies carry meningitis shots for $40. Flu shots are $10-40 without insurance.

    A big part of the problem, at least in the US, is that people don’t see the diseases covered by these vaccinations as a threat. If they don’t personally know anyone who’s gotten the disease or has died from it, it doesn’t cross their radar. So there’s a real lack of motivation to get vaccinated, unless they’re in the middle of an outbreak.

  16. 16
    24fps

    I live in Saskatchewan, Canada. Last year, 5 babies died of pertussis here. Not one of them made the news, though – they were all first nations kids living on reservations.

    I got my booster when I was in the immunization clinic for some travel shots. The thing is, if you don’t ask you might not know if you need a booster. My mother didn’t until I told her, since my niece was expecting a baby soon, that she might want to go to the clinic and get one. Cost isn’t a factor here, either, it’s covered by our health system.

  17. 17
    macrophage

    Arkady, I believe I didn’t fully answer your question about US healthcare. I work in a lab that handles human pathogens as well. In order for me to get a vaccine and have it be paid for by my employer I first have to get a form from HR (human relations) that authorizes me to get the vaccine. Then I have to schedule the injection with the occupational health people at a clinic across town. Then I go there and go through a series of question and answer and physical exams. And then I get the vaccine. I’m given another form that has to be taken back to HR for review.

    Some vaccinations require I make an earlier appointment to have an antibody titer measured. But I would still need all the same authorization forms via HR.

    Because this is through my employer all of the information can also be reported to any member of the public or press via FOIA (freedom of information act). So…if I want all of my medical stuff to be 100% private I have to pay for all this myself and go through my private physician. And then produce a document that says it’s all been taken care of.

  18. 18
    skeptifem

    @14 arklady

    People without insurance don’t typically go to the doctor as much as people who have it. People without insurance can go to free clinics and such but the resources are limited because they rely either on government money or charities. Most people without insurance seem to go to the doctor or clinic when they are having a problem instead of paying for preventative care (like annual check ups). It seems likely to me that vaccination schedules are probably examined more on well child visits or annual physicals than at visits made for a specific problem.

  19. 19
    Starmom

    A couple of years ago I wandered into the doctor’s office for something trivial, back pain maybe, and the nurse informed me that I was getting a Tdap shot because I was of grandparent age; they were vaccinating as many people as possible in the course of seeing them. Now I just need some grandbabies!

  20. 20
    whheydt

    I live in an extended family, consisting of me, my wife, our daughter, our son-in-law and our 4-year-old grandson.

    A couple of years ago when Pertussis started cropping up more, my wife and I arranged with our doctor to get TDAP shots. At first he was reluctant (age–I’m now 63–and herd immunity), but when I noted that it was to protect a 2-year-old, he saw the light and readily agreed (he would have agreed anyway, so long as I insisted, but the logic of the situation brought him around fast).

    –W. H. Heydt

  21. 21
    Lynna, OM

    Whooping cough cases “raging through Utah.”

    http://www.sltrib.com/sltrib/news/54477353-78/cough-whooping-cases-pertussis.html.csp

    Excerpt:

    July, 2012
    …Foy, 41, is just one of hundreds of Utahns who have contracted whooping cough, which is sweeping through the state.

    “It’s [infecting] record numbers, and it’s raging through the county. In fact, numbers are elevated statewide,” said Ilene Risk, epidemiology bureau director for the Salt Lake Valley Health Department.

    Risk said 280 cases of whooping cough have been reported in the valley so far this year, and it’s estimated that each case represents 10 to 20 cases that go unreported. In the past two weeks, 21 new cases have been tallied, which is 10 more than the five-year average during the same time frame, Risk said.

    According to the Centers for Disease Control and Prevention (CDC), Utah is one of 37 states that has reported increase in cases of whooping cough, also known as pertussis, through July compared with the same month in 2011. More than 17,000 cases were reported to CDC through July 12, including 10 pertussis-related deaths. Most cases occur in infants, but rates are also increasing in children ages 7 through 10 and in adolescents 13 and 14….

  22. 22
    Lynna, OM

    From the reader’s comments section below the article in the Salt Lake Tribune (link in comment #21):

    I investigate infectious diseases for Public Health. One of the arguments that those who are anti-vaccine have is that most of the people who get the infection are vaccinated. This is a misinterpretation of the data.

    It is true that many of my reports (lab-confirmed) turn out to be a person who is fully vaccinated. However, those are just the lab reports, not the actual number of those who have the disease. When I receive a lab report, I contact the person who was tested (or the parent) and find out if there are any close contacts who have the symptoms. If a close contact (usually a household member) meets the criteria of symptoms within the infectious/incubation period timeline, that that second person is also considered a case.

    Also, I only receive reports when 1) a person goes to a medical provider; 2) the provider tests; and 3) the test is positive. So we also need to be aware that there are many different populations that, for different reasons, have the infection but it is not reported. This skews the numbers greatly about which population actually has the infection.

    I have found that the great majority of my cases who are vaccinated had no spread to other vaccinated household members – meaning that one out of the entire household did not attain immunity, but the rest of the household did. So the vaccine was not effective in the one case, but was completely effective in the rest of the household members.

    Another thing that I have found is that many times these statistics do not work for those cases who come from families that do not believe in vaccinations. When I investigate a case in that category, the person that I interview may be very uncooperative, or reluctant, to share any information regarding household members who might be considered cases. Therefore, out of that household, I can only count one case, skewing the statistics.

    In an unvaccinated household where the interviewee is cooperative, I find that the household infection rate is close to 100%.

    I know that each side can argue until blue in the face about the pros and cons of vaccination, and no one would change their minds; however, I believe that we need to know the statistics, and the correct way to interpret them.

  23. 23
    coraquilonis

    RE: vaccination coverage

    After my infancy, my Mom was an anti-vaxxer (before it was cool). Now that I’m employed in a job with health care coverage and have a healthcare spending account (HSA with HDHP), I’ve been catching up on vaccinations.

    So far I’ve had tetanus (and whatever comes with) along with MMR (Measels, Mumps, and Rubella), Meningitis, Hepatitis B, and Guardasil (HPV). It’s cost me hundreds and hundreds of dollars (total) from my HSA spending account, since it’s all under the deductible or not covered. Off the top of my head, the Hep B was $80 per shot (two or three rounds, I think), and the Guardasil was about $150 per shot, with three rounds. I don’t remember the others. Happily I already have a few basics like the Polio vaccine from my childhood.

    Vaccines as an adult are quite expensive. Hope this helps.

  24. 24
    Terska

    My fully vaccinated teenager contracted pertussis this year. He didn’t get as ill as an unvaccinated person but he missed 28 days of school over the winter and spring and nearly didn’t advance to the next grade. On and off low grade fevers and a painful cough. There really wasn’t any effective treatment. We discovered eventually he has a somewhat weak immune system and will need many of his vaccines again.

  25. 25
    Gregory in Seattle

    In all of 2011, there were 312 cases of pertussis reported to Washington State health officials. As of August 11, 2012, there have been 3,484 in just this year alone. Of that 3,484, 220 were in children younger than one year old. We officially crossed the threshold into a state-wide epidemic in December. The worst hit part of the state is Skagit County in the northwest: year to date, the infection rate there stands at 455.2 infections per 100,000 population. Second worst rate is in Whatcome County immediately to the north, where the YTD infection rate stands at 130.9 per 100,000 population. Altogether, Washington has seen about 22,000 cases this year, and there have been 13 deaths officially attributed to the disease. Most of those deaths have involved children younger than 1 year old.

    For all that, Washington is actually #2 on the list of states. The national average for pertussis this year is 5.24 cases per 100,000 population. Washington as a whole is at 39.2; Wisconsin is #1, with 50.7.

    Anti-vax websites are claiming that the epidemic is being caused by a novel strain that has, somehow, remained localized to parts of the state with very strong anti-vax sentiment. They like to claim that the CDC has absolved the anti-vaxxers of all responsibility, when in fact the CDC has merely stated that there is not enough hard evidence to blame them.

  26. 26
    TerranRich, Yet Another Atheist

    This logic is prevalent whenever there’s medication of some sort involved. “Hey, whooping cough isn’t a problem anymore, so let’s stop vaccinating, because of some ooga-booga pseudo-science I read somewhere,” is along the same lines of, “I feel fine after taking antidepressants/antipsychotics/etc, and they probably do more harm anyway, so I’ll stop taking my meds!”

  27. 27
    Gregory in Seattle

    @Terska #24 – No vaccine is able to give 100% immunity: there is simply too much variability in the human immune system.

    A vaccine is considered effective if it can prevent the disease in at least 95% of the people who get it, a fact that a lot of anti-vaxxers use to dismiss all vaccines. Their “thinking” (sic) is rather like saying that since condoms are only 98.5% effective, then there is no point in using one.

  28. 28
    TX_secular

    My husband and I were vaccinated with the DTap because the pediatrician our daughter uses for her kids told her that we needed them to protect the kids. I would not have thought to get these vaccines so the doctor’s advice really made a difference. We also got the Hep series while we were at it, why not? Our local county health clinic here in Central Texas provides all kinds of vaccines for free or very cheaply (depending on income). In fact, my primary care physician refers to the clinic for all vaccines.

  29. 29
    emburii

    How about you pay for my doctor’s visit (without insurance, natch), or pay the thirty dollars copay (that we can’t afford) for my partner to go get it, and then we’ll discuss why the uptake might be a little low.
    I would take the booster in a heartbeat, but from what I can tell it’s only free for students. And when it’s a choice between the gas to drive my partner to work so that we have at least one income stream (I’m unemployed) or getting this booster when I don’t have much contact with children anyway, I’m afraid my gas tank wins. I don’t WANT to make that choice, but I do want to eat.

  30. 30
    joed

    http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/WhoopingCough.aspx

    Pertussis Epidemic 2012
    Pertussis cases in Washington, 2012

    Pertussis cases reported in 2012

    3,484

    Cases reported for the same period in 2011
    312

    New cases reported August 5-Aug 11, 2012
    80
    Age groups with highest rate
    Children under age 1
    Children ages 10 to 13
    Cases in babies under age one in 2012
    220
    County with highest rate

    See full weekly report for details and numbers by county.

  31. 31
    Markita Lynda—threadrupt

    At my last examination I asked about dwindling immunity from old vaccinations and the doctor said that was being checked with my blood work. I’ll be following up on her at my next visit to clear up a few loose ends.

  32. 32
    andrewriding

    Sadly I had never heard that there was supposed to be a booster shot for this. I came down with it just two weeks into a job and am the most probably vector by which my sister and her children caught it (undiagnosed and with somewhat different symptoms but a nasty cough in the expected time frame after mine.) Luckily nothing too terrible came of it, though my sister seems to have used it as further evidence than vaccines don’t work so well that she should give the full selection of them to her children.

    She says a lot of sentences I agree with about not being able to trust single sources and such but she’s listened to a lot of different people supporting anti-vax ideas and can’t distinguish reputable sources. She can’t give me a full list of them either so I know I won’t be able to meet her standards to show that she’s had a really biased exposure before she gets sick of dealing with me and takes the topic off the table for polite conversation.

  33. 33
    michaelbusch

    @Gregory in Seattle @27:

    The pertussis vaccine is only ~85% effective ( http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001478.pub5/abstract;jsessionid=1E649C4918E1F75FFF21F629716F4197.d03t01 ). That’s relatively low, but it is enough to make the average number of people a carrier infects less than 1 and so prevent epidemics – as long as everyone gets vaccinated and keeps up with their boosters.

    Even with herd immunity at 85% (that is, 100% vaccination), there will still be clusters of pertussis cases as long as there is any reservoir of the disease. I was part of such a cluster when I was in grade school – 4 cases: me, my brother, my cousin, and one of my cousin’s friends, if I remember correctly. But herd immunity meant that we were a cluster of 4 cases rather than the start of an outbreak of 400.

    So, everybody: get your boosters as well as making it clear to the anti-vaxxers the harm that they are doing.

  34. 34
    cathynewman

    @29 emburii:
    Community health clinic. In every city I’ve lived in, the health clinic has major vaccines (DTap booster, etc.) for free or very cheap ($5 or less). And no co-pay. That’s what they’re there for.

  35. 35
    No Light

    In England and Wales we’ve had three infant deaths from pertussis this year.

    From January to March we had 668 confirmed infections. In the whole of 2011 we had. 1140. It’s scary stuff.

    I can’t be vaccinated for several viral illnesses, and I have a compromised immune system. I’ve had pertussis. It was in the winter of 2010. I coughed myself purple and puking for two months. I broke my ribs, burst blood vessels in my eyes and on my cheeks, and got whiplash in my neck from the force of the coughing.

    I’m a grownup, I knew what was happening. When I think of a baby or young child going through what I went through I want to sob. It must be so terrifying.

    I think anti-vaxers are scum. I also think the US could help by making vaccinations available for free, to maximise take-up among people who want them, but can’t afford them.

  36. 36
    cathynewman

    When I started working at a Univ. California campus as an employee and switched to a new phenomenal health plan that covered just about everything imaginable, I started seeing a new doctor for regular preventative care. During the very first visit, she went through my medical history with me and checked to make sure I was up to date on all of my vaccines. I’d had to get a DTap booster a couple years earlier for school, but otherwise I would not have known I’d needed boosters. The US is definitely very backwards when it comes to [lack of] focus on preventative health care.

  37. 37
    emburii

    cathynewman

    …huh. I shall go research this.

  38. 38
    Compuholic

    A question for the doctors amoung the crowd.

    This article reminded me to check wheter my vaccinations are up to date. I usually don’t check my vaccination record myself and I usually just hand it over to my doc and let him see if anything needs to be done.

    So I just went over the record myself and noticed something odd. The entries show that I was regularly vaccinated against Tetatus, Diphteria and Polio and tick bourne encephalitis (probably a european thing) but there are many blank spots in the record. For example it shows I never got any vacinnations against pertussies, Hep A or typhoid fever (and a few other things).

    So my question: Is that normal? I could imagine that the diseases are so rare that the chance of complications caused by vaccination outweight the risk of actually contracting the disease. Or do I have an incompetent doctor?

    Thanks

  39. 39
    Makoto

    I cheer on my brother and sister-in-law when they say they won’t allow ANY family member near my 1 year old niece unless they’re up to date on vaccinations, especially TDAP.

  40. 40
    Compuholic

    Oh I forgot something:

    What strikes me as really odd is that I never recieved any vaccines against measles, mumps or rubella. Maybe I did as a child but I don’t know since my record doesn’t go that far.

    Thanks for your help

  41. 41
    Gregory in Seattle

    @michaelbusch #33 – The study you linked is about acellular pertussis vaccines, which is made up of specific antigens rather than the whole, killed bacterium. Most pertussis vaccines in the US are cellular rather than acellular, and have a significantly higher efficacy.

    In the US, infants and children typically get the DTaP combo vaccine. The DTP indicate diptheria, tetanus and pertussis; the capital letters indicate a full dose of the specific vaccine, and the a after the T indicates that the tetanus is acellular. Adolescents and adults get the Tdap combo, which has the full strength of tetanus and a weaker dose of diptheria and pertussis (which is why they are in lower case.) The a after the d indicates that the diptheria vaccine is acellular. The difference between the two combo vaccines has to do with relative risk by age group, and the fact that diptheria and pertusiss need only small boosts to remain effective.

  42. 42
    chris

    Compuholic, whether or not you had a vaccine may be related to your age. I have been vaccinated for typhoid, but that was because I was born while my father was an Army officer living overseas, so I got lots of extras (including a yellow fever vaccine).

    I never had the MMR because it came out in the USA when I was teenager. I do remember actually getting mumps, the year the vaccine was introduced in 1968.

  43. 43
    kristinc, now with added ventilation

    Community health clinic. In every city I’ve lived in, the health clinic has major vaccines (DTap booster, etc.) for free or very cheap ($5 or less). And no co-pay. That’s what they’re there for.

    Your central point is true enough and people should definitely look into those resources but I’ve been dependent on them and they are … not ideal. Often they’re one town over and have limited hours. With the cost of gas the way it is and low-paying jobs being the least likely to grant time off that can pose a huge problem. Other times they have long waiting lists. In short, they often suck rocks, and if we were really serious about keeping everyone vaccinated we would have a clinic in every town with evening hours and sufficient staff to not have long waits.

  44. 44
    chris

    Gregory in Seattle:

    the a after the T indicates that the tetanus is acellular.

    Actually that is referring to the “P” after the “a”, it is the pertussis that is acellular. Hence the “a” before the “p” in Tdap, and still refers to pertussis (not diphtheria). More info at the CDC Pink Book Pertussis Chapter.

    Also, neither the diphtheria nor the tetanus part of the vaccine are the bacteria, they are actually made from the bacterial toxin. The tetanus toxoid is created by treating the tetanus toxin with formaldehyde. The diphtheria toxoid is created in a similar fashion. From the CDC Pink Book Tetanus Chapter:

    Tetanus toxoid is available as a single-antigen preparation, combined with diphtheria toxoid as pediatric diphtheriatetanus toxoid (DT) or adult tetanus-diphtheria (Td), and with both diphtheria toxoid and acellular pertussis vaccine as DTaP or Tdap. Tetanus toxoid is also available as combined DTaP-HepB-IPV (Pediarix) and DTaP-IPV/Hib (Pentacel—see Chapter 15 for more information). Pediatric formulations (DT and DTaP) contain a similar amount of tetanus toxoid as adult Td, but contain 3 to 4 times as much diphtheria toxoid. Children younger than 7 years of age should receive either DTaP or pediatric DT. Persons 7 years of age or older should receive the adult formulation (adult Td), even if they have not completed a series of DTaP or pediatric DT. The use of
    single-antigen tetanus toxoid is not recommended. Tetanus toxoid should be given in combination with diphtheria toxoid, since periodic boosting is needed for both antigens.

    The CDC Pink Book is a very handy reference.

    The other terrible thing about the anti-vax movement is that they are also not protecting their children from tetanus (which is in the environment), nor from diphtheria. About twenty years ago diphtheria came back in full force to the former Soviet states causing around four thousand deaths:
    Diphtheria in the former Soviet Union: reemergence of a pandemic disease.

  45. 45
    michaelbusch

    @Gregory in Seattle @41:

    Good point. But the DTaP is only as effective in preventing pertussis as the older pertussis-only vaccination (http://www.immunizationinfo.org/vaccines/pertussis-whooping-cough). What it does do exceptionally well is to make those cases of the disease that do occur relatively mild, which is a very good thing. So rather than No Light’s ordeal, I spent no more than 10 days coughing my lungs out.

    @Compuholic:

    Some of the vaccine recommendations differ from place to place. For example, Hep A isn’t recommended for adults in the continental US because the incidence is relatively low. But I got a booster series because I spend a fair amount of time in Puerto Rico, where it is more common.

    The CDC’s adult vaccination schedule (available at http://www.cdc.gov/vaccines/schedules/hcp/adult.html ) is color-coded to show which vaccinations are recommended in which circumstances. If you have no record of getting the MMR vaccine and are under age 55, get it. Likewise for the Tdap booster series.

    Also: in the interests of full disclosure, I’m not that kind of doctor.

  46. 46
    Alethea Kuiper-Belt

    Beatrice, the cavalier attitude to boosters is probably more ignorance than laziness. It’s only become medically recommended sometime in the last few years; people used to believe that the full course gave lifetime immunity.

    I’ve had mine.

    Michael, why should I get MMR? I’ve had rubella vax, but when I was a child the MMR did not exist. I had a nasty case of measles with complications when I was six.

  47. 47
    Stardrake

    One possible good sign I saw here–one of the local grocery chains (Rainbow Foods, for the Mpls/St. Paul locals) was advertising whooping cough vaccinations. (Cost unknown–the sign didn’t say). Grocery store vaccinations do tend to be low-cost, to get people in the stores, which could help.

    Of course, it’s not as good as a proper health-care system would be, but it’s something.

  48. 48
    michaelbusch

    @Alethea @46:

    The recommendation is “for all persons who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection”.

    So if you’ve had measles and been vaccinated for rubella, but have not had and were not vaccinated for mumps, you should ask your doctor about getting a dose of MMR – you’re still missing immunity to one of the three. I don’t know if the mumps vaccine is still packaged separately or not.

  49. 49
    vyyle

    If I’m remembering my microbiology class correctly, children are actually more often infected by asymptomatic adults than other children. It is possible for an infant to contract pertussis from a vaccinated, non-symptomatic adult. The vaccine wears off, and it is possible to be colonized with the bacteria even when you do have the antibody against it.
    A colonized individual does not necessarily become symptomatic, and even when they do show respiratory symptoms they are not necessarily the characteristic ones that would lead physicians to suspect the disease, and they can be dismissed as some other form of respiratory infection.

    That being said, it is less likely for a child to become infected if all of the adults involved in their care have had recent booster shots. It’s worth it for parents to get the shot, and strongly suggest to any relatives that will be spending time with the child to do the same. It’s especially worth it for the mother, because a boost in her antibody titer can directly affect the infant’s likelihood of being infected between birth and reaching the age where they can be vaccinated.

    It’s also a question that might be worthwhile asking when looking for daycare.

    @46 You should consider either the MMR or a mumps vaccine. Mumps is a nasty disease if you get it older. More so for men than women, but still pretty nasty.

  50. 50
    A. R

    This is why I push vaccines on every new parent I talk to. High efficacy to cost ratio, few to no adverse effects (Granted, if you go out and get every vaccine known to man like I have, it gets a little interesting eventually), and, most importantly, they prevent your kid from fucking dying.

  51. 51
    Ichthyic

    However, it is *possible* that this wasn’t due to the anti-vaxers being in the picture.

    of course.

    yet I can point to a specific case that happened here in NZ 2 years ago, where the outbreak of a serious epidemic (still going on) of whooping cough was indeed directly traced to a family that refused to get their kids (or themselves) immunized, went on a trip to thailand, and brought it back with them.

    4 kids are DEAD because of that, hundreds more people are infected with whooping cough.

    there are no plans to bring any charges against the people responsible however, because there is no law categorizing such irresponsible behavior as criminally negligent.

    my question is:

    should there be?

    I think so.

  52. 52
    Ichthyic

    and, most importantly, they prevent your kid from fucking dying.

    of at least equal importance is that it keeps OTHER PEOPLES kids from dying.

  53. 53
    Ichthyic

    my Mom was an anti-vaxxer (before it was cool)

    before it was cool…

    saddest statement I’ve heard all day.

    :(

  54. 54
    Jessa

    As much as I loathe anti-vaxxers, I’m not sure how much of a role the anti-vax mentality played. I live in NC, and during my annual checkup in 2009 I insisted on getting vaccinated because my sister-in-law was pregnant, and I knew that I would be spending quite a bit of time around my new nephew soon. The PA seemed puzzled about why I would want to be vaccinated. It turned out that their judgement on whether to vaccinate hinged on the answer to “Do you have any children under two living with you?”. I answered “No” truthfully, so it wasn’t recommended. I wonder how many other people with close contact to young children didn’t get vaccinated because they didn’t fit the narrow criteria on a questionnaire.

  55. 55
    croquetplayer

    I live in San Francisco and popped into a Walgreens for a quick Tdap shot. No appointment, no wait. I was feeling so virtuous I then popped into the bar across the street for a quick Jameson’s shot. And that’s how we do disease prevention San Francisco style. ;)

    http://www.walgreens.com/marketing/library/contents.jsp?doctype=1&docid=007334

  56. 56
    jamessmithson

    I live in Vermont where there is a problem of high philosophical exemption rates. Recently the philosophical exemption portion of the exemption law was amended, removing those exemptions leaving only religious and medical exemptions, but the spineless cowards in the state government caved to pressure from anti-vax groups and left all exemptions as they were. Instead now parents have to sign a statement acknowledging that their actions put other children at risk if they seek a non medical exemption for their child.

    http://7d.blogs.com/blurt/2012/05/on-last-day-of-legislature-senate-takes-one-more-shot-at-vaccine-bill.html

    “The bill passed Saturday maintains the philosophical and religious exemptions. But it will require parents to provide schools and day care providers with a signed statement — every year — declaring, among other things, that they understand:

    “There are persons with special health needs attending schools and child care facilities who are unable to be vaccinated or who are at heightened risk of contracting a vaccine-preventable communicable disease and for whom such a disease could be life-threatening.”

    Sen. Phillip Baruth (D-Chittenden, pictured) called that language “coercive” and said it forces parents annually to “certify that their actions could endanger other kids.”

    “We’re basically saying, ‘We would like to take your rights away. We’re not going to do it, but we’re going to make you sign a form saying we were right all along,’” Baruth said.”

    Phillip Baruth is a fucking asshole. A scientifically illiterate tool who doesn’t have a clue what he’s talking about. It’s unfortunate that “liberals” are pretty much as bad as YECs and homophobes when it comes to this issue.

  57. 57
    Dalillama, Schmott Guy

    @ Ichthyic

    my question is:

    should there be?

    I think so.

    Damn skippy there should be. I’d personally call it equivalent to as as many counts of attempted murder as there are pertussis cases, and as many counts of murder as there are bodies, and both parents should suffer the maximum penalty allowed by law for those crimes.
    @Jamessmithson
    The ‘philosophical and religious’ objections clauses make my blood boil. As far as I’m concerned, if there’s not a medical reason your child can’t get a full spectrum of vaccinations, failure to do so is child abuse. If it were made legally child abuse, there would of course have to be free vaccinations offered to all new parents for the benefit of the low-income, or, you know, a single payer health care system.

  58. 58
    Stella

    Yikes! I did not know that adults need booster shots for pertussis. I guess it’s one of those things I don’t think too much about (because I thought I was up to date on my shots) and just sort of thought the doctor would tell me about if I needed it. That’s scary.

  59. 59
    julietdefarge

    If you live in VA, be especially careful:
    http://www2.wsls.com/lifestyles/2012/jan/30/pertussis-cases-going-virginia-ar-1651533/

    Beware of Grandma. Not only is she the one most likely to think she’s too old to need any shots, she’s also most likely to think this peanut allergy stuff is a bunch of hooey.

  60. 60
    colonelzen

    Are you up to date on your shots?

    No, Then no, you can’t date my daughter.

    (Kids are grown now so that’s not really a viable option. One has a bio degree and is quite likely herself to ask such questions of someone she becomes involved with).

    – TWZ

  61. 61
    Giliell, professional cynic -Ilk-

    This is the moment the beats roars.
    If you know Sam Vimes, you know what I mean.
    This beast that hears that shit and just wants to make people who do such things hurt, hurt, hurt. Of course I’m watching the beast. I know it’s the beast, I don’t let it decide my reaction. But man, it roars.
    There were two very happy moments in my parenting life: When both kids got their MMRV vaccination. Especially with the little one I was really afraid that she’d pick up measles from an unvaccinated child when I brought her sister to kindergarten.

    Sadly, adult vaccination is not routinely done here.

  62. 62
    Giliell, professional cynic -Ilk-

    colonelson

    Are you up to date on your shots?

    No, Then no, you can’t date my daughter.

    Uhm, no. I know, you mean it as a joke, but daughters ain’t property.

    +++
    Question: How much protection do you have if you had Pertusis as a child?
    I just checked my record: I’ve never been vaccinated and since there’s no single vaccine avaible here and you can only get the DTP vaccine 5 years after your last DT shot (that means in 4 years and 10 months), I’m wondering…

  63. 63
    dianne

    How much protection do you have if you had Pertusis as a child?

    Caution: I don’t know the actual answer, but I strongly suspect that it wanes much like induced immunity, aka vaccination. Exotic trip to the US for vaccination and tourism?

  64. 64
    David Marjanović

    Beatrice, the cavalier attitude to boosters is probably more ignorance than laziness. It’s only become medically recommended sometime in the last few years; people used to believe that the full course gave lifetime immunity.

    Yep. I’ve heard of boosters for whooping cough vaccination on Pharyngula first.

    I actually got whooping cough when I was 10. It was rather mild, probably because I was vaccinated.

    Oh, and, I was never vaccinated against rubella. Only the girls were – in school.

  65. 65
    Giliell, professional cynic -Ilk-

    dianne

    Exotic trip to the US for vaccination and tourism?

    Thanks, but I won’t be visiting a country that treats me like a criminal rather than a guest. ;)
    Do you have a single pertusis shot?

  66. 66
    anubisprime

    Between the anti-vaxxers, the alternate medicine brigade, the rabidly religious, the rabidly sexually inadequate religious,the climate change deniers, the generally incompetent, politicians with less brains then snot and the insanely twisted…

    this world is not a very safe place for kiddies, or grown ups come to that!

  67. 67
    blf

    politicians with less brains then snot, peas

    Fixed.

  68. 68
    chrismclaughlin

    Correct me if I’m wrong, but vaccinations are not 100% effective in 100% of recipients. Some percentage of vaccinations don’t “take” in some cases in some people. If this is the case, then we can’t blame anti-vaxers for this tragedy because we can’t be sure that a non-vaccinated person was responsible.

    I think the anti-vaxers are idiots who put themselves and others at risk, but I wouldn’t want to look foolish by blaming them for something so easily refuted.

  69. 69
    chris

    colonelson:

    Question: How much protection do you have if you had Pertusis as a child?

    It is variable. Sometimes for the rest of your life, or it fades away in as little as four years. An actual citation: Duration of immunity against pertussis after natural infection or vaccination. The only way to get an adult pertussis is with the Tdap. Yes, it also includes a booster for tetanus and diphtheria, but we have had ten year boosters for those for decades.

    chrismclaughlin:

    If this is the case, then we can’t blame anti-vaxers for this tragedy because we can’t be sure that a non-vaccinated person was responsible.

    One can never find out what individual is responsible, but it is the non-compliance with vaccine schedules that increases the risk of getting pertussis and the tragic deaths of infants. Studies have shown that the more people who do not vaccinate increases the level of the disease. Again some citations:

    Pediatrics. 2009 Jun;123(6):1446-51.
    Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.

    Am J Epidemiol. 2008 Dec 15;168(12):1389-96. Epub 2008 Oct 15.
    Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis.

    JAMA. 2000 Dec 27;284(24):3145-50.
    Individual and community risks of measles and pertussis associated with personal exemptions to immunization.

    The following compares countries that had anti-vaccine campaigns that even affected the vaccine schedule, and those that did not: Impact of anti-vaccine movements on pertussis control: the untold story.

  70. 70
    vyyle

    To the couple of people who were asking whether they needed to keep up with pertussis vaccination if they’ve had the disease as children, the answer is yes.

    Pertussis has a completely different pathogenicity and immune response than many of the diseases that you become completely immune to once you’ve had them. You do not necessarily become ‘immune’ to whooping cough in the same way that you would become immune to the measles or chicken pox; it is still possible to become colonized.

  71. 71
    Giliell, professional cynic -Ilk-

    chris
    That was me, not colonelson ;)
    Thanx for the response. Unfortunately I just had the Tetanus booster 6 weeks ago with no added pertusis :(

  72. 72
    chris

    Oops, sorry. Mixed up with the blockquote.

    Yeah, I know what you mean. I got my previous tetanus booster in 2005 just before the Tdap was approved. But because of the pertussis situation in our county (close to epidemic) our family doctor made sure all of had a Tdap.

  73. 73
    robwickstrom

    Sorry to sound ignorant for a moment, but is there a chance that this year’s outbreak may be worse due to this season being in one of the naturally peak years and then other possible factors like the US Gov and the two whistle blowers suing Merk over the falsified testing that places it the actually immunity at well below the contractual 95% rate for the MMRII? If the same dirty business practices had been going on for the TDap, could this be one of the factors to think about.
    I just find it odd that every time the industry pushes so hard for vaccinations, there is an increase in the number of cases about the same time.
    It isn’t only Merk as of late, GSK has also been pinched with the H1N1 as well.

    I for one, only go with the “clean vaccines” and not the multi-dose due to the adjuvants and preservatives that I don’t trust.

    I only ask due to me contracting mumps 5 years ago from kids that contracted the Laboratory strain. Here in Japan, the number of cases was quite high due to the vaccinations and not the “wild” virus.

    Like I said, I am just trying to figure it all out and most here sound like they are connected to the medical research industry.

  74. 74
    chris

    robwickstrom, to see if you understand the issues surrounding the mumps vaccine, please tell us which vaccine strain it is about: Rubini, Zagreb-Leningrad, Jeryl Lynn or Urabe. (hint: go to the PubMed index and look them up)

    And when did Japan start vaccinating for mumps after dropping it a decade ago? I noticed that mumps was circulating because the mumps vaccine was voluntary:
    http://www.ncbi.nlm.nih.gov/pubmed/20870055

    Which prompted this study:
    http://www.ncbi.nlm.nih.gov/pubmed/19209100

  75. 75
    chris

    And to help you out, let me repeat a couple of paragraphs from article:

    “Merck has presented information that demonstrated to the United States Department of Justice that these allegations are factually false, and after the Department conducted its own two-year investigation, it decided not to pursue this lawsuit,” Rogers said.
    In addition, he said, the U.S. Food and Drug Administration “previously examined the issues raised in the lawsuit, and they were resolved to the agency’s satisfaction.”

    If you do a PubMed search for studies on mumps efficacy, you will realize it is silly suit.

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