Wednesday, October 10, 2012

Whooping Cough and Adult Vaccination

The article below is a narrative of the author's experience only. It is a commentary and is not meant to provide medical advice or direction.

The other day I opened my mail and there was a personal letter from a close relative with a small card inside that has a picture of a baby and says “Can you protect me from whooping cough by helping to protect yourself? Ask your health care provider about the adult pertussis vaccine.” Also included was a written note from my relative who is days away from having her first child. The note asked me to please update my booster shot before I come meet the newborn baby.

I recalled hearing a news story some time in the last year about the increasing incidence of whooping cough in the U.S. I started thinking about how much of a concern this is for parents today. It seemed like an unusual request and that my relative was asking a lot of me – to take time off work for a doctor's appointment and put something foreign into my asthmatic body. I do not take this lightly. On the other hand, if this is a medical necessity, I'd get the vaccine despite my admitted discomfort with it. The problem is, medicine is an inexact science and there is no real absolute; determining necessity is not always possible.

I figured that my relative's doctor must have given her a stack of these cards to hand out to people. But when I asked her this she said they did not come from her doctor, but rather that after she bough maternity clothes she started getting all sorts of baby-related brochures and solicitations in the mail and this was among them. I turned the card over and read the tiny faint print at the bottom: “Brought to you as a public health service by Sanofi Pasteur Inc.” I went to the company's website where I read that they are “the largest company in the world devoted entirely to human vaccines.” The card also noted a website called which looks to be largely a marketing pitch for the vaccine, but it does have a reference page that lists 17 scientific journal articles. I was glad to see this listing, though the actual content or thesis of the articles and how well the statistics were translated into the content of this website is beyond the scope of my analysis. About half of the 17 articles were credited to the Centers for Disease Control (CDC).

I wanted to get some facts and make an informed decision, so I went to the website and read everything I could find about this disease. The site noted that whooping cough is a common disease in the U.S. with 3 to 5 year cyclical peaks and frequent outbreaks. The FAQ page noted that there are “about 10,000 - 25,000 cases reported each year and unfortunately about 10-20 deaths” with most of the deaths occurring in newborn infants. Besides death, there are other complications that can also occur with the disease. The vaccination page section of the CDC website says “From 2000 through 2008, 181 persons died from pertussis; 166 of these were less than six months old. Before pertussis immunizations were available, nearly all children developed whooping cough. In the U.S., prior to pertussis immunization, between 150,000 and 260,000 cases of pertussis were reported each year, with up to 9,000 pertussis-related deaths... Pertussis cases occur throughout the world. If we stopped pertussis immunizations in the U.S., we would experience a massive resurgence of pertussis disease. A study [Lancet reference provided] found that, in eight countries where immunization coverage was reduced, incidence rates of pertussis surged to 10 to 100 times the rates in countries where vaccination rates were sustained.” [bold emphasis from].

So it's clear that widespread introduction of the vaccine has drastically reduced the disease and that infants and children should continue to get the vaccine. But what about adults? Looking further I found that the CDC site says “getting vaccinated … before coming into close contact with an infant is especially important for adults who are around infants. Remember that even fully-vaccinated adults can get pertussis. If you are caring for infants, check with your healthcare provider about what's best for your situation.”

This is really confusing to me. Getting vaccinated is supposed to prevent you from getting a disease, but the CDC cautions that even fully-vaccinated, you can still get the disease. So getting vaccinated doesn't eliminate your risk, but it lowers it? By how much? I was only able to find something saying that the vaccine isn't 100% effective because pertussis is a very contagious disease. They say that getting vaccinated is especially important but then to check with your doctor about what's best for you.

I called my primary care doctor, an internist here in Middletown, and left a message asking if he could call me with his opinion of this. One of his staff members called me back and said that they typically only give the adult vaccine to the parents or caregiving adults that are going to be taking care of the baby daily. Ultimately, she said that it is my decision.

I live in a different state from my relative, and I'll be going for a ten-day visit with her, so it's kind of a grey area in terms of daily interaction with the baby. I will see the baby every day for ten days in a row, but not with the same intensity that a primary caregiver will. I don't feel sick, and I'm pretty sure I don't have whooping cough right now. How can I put the baby at risk if I am not sick?

I found a different website called the National Vaccine Information Center, claiming that “pertussis vaccines, which can contain various amounts of bioactive toxins and also aluminum and mercury additives, have killed and brain injured some children. [8 references provided]. … Even with super high pertussis vaccine coverage in America and other countries … whooping cough disease cannot be prevented. ... Unknown numbers of children and adults, who have gotten all government recommended pertussis shots, can and do develop whooping cough or are carriers without symptoms. [2 references provided]”

This website seems to be making the case against getting vaccinated, or at least pointing out the potential drawbacks or cautions, but they've actually got me more convinced that I should get vaccinated. That last phrase, “carriers without symptoms” really got to me. I or anyone I know might be blithely going about our business while unknowingly spreading the disease around the community. Well, the internet does it again. You can pretty much find anything to support any opinion. And as with all things medical, to a large extent it just comes down to doing what you think is best. I trust the CDC, and their information indicates that I should get the vaccination, but my doctor left the decision up to me.

I asked Louis Carta, MA, the Community Health Educator for
the Middletown Health Department, how many cases of pertussis have been reported here. He said “To my knowledge, there have been two reported cases of Bordetella pertussis in Middletown within the past 5 years. We recommend that adults consult their own health care provider for guidance on this issue.”

I understand the parental instinct to do everything possible to protect your children, but how far does it go? I really don't like the idea of getting a vaccine, and I don't think that I am alone in this. It is difficult to explain in logical terms my opposition. It is not quite a fear, it is more of an instinct. I know rationally that a vaccine is not likely to cause me any harm. In fact, the CDC website says that it is much more dangerous to get a case of pertussis than to get the vaccine even considering the mild side effects possible. But, I never get flu shots and don't worry about getting the flu. My employer required me to get a tetanus shot in the past and that was a struggle too. But now, it's not just about my own personal choices in regards to my own health. There is a community aspect to it, after all, the illness is communicable. I have an interest in keeping peace in my family, as well as protecting my newborn relative. To me, this is just as much about navigating family relationships and being left to gather information and decide for myself what to do when it comes to medical decisions. 


Rachel said...

Thank you for this essay.. I also struggle with the idea of vaccines for adults (and even children). I never get a flu shot, and I don't give one to my son, but find it uncomfortable to have to deal with the disapproving looks and constant push in the mail, on TV, in the doctor's office, and in just about every drug store. I find it especially interesting that the card your relative sent was provided to her by the manufacturer of the vaccine, confirming a theory I have maintained for quite some time - that the need for such medicines is exaggerated in order to make even more money for Big Pharma. I have no interest in having a vaccine injected in me to reduce the fairly small risk I already faced of getting some sort of ailment. I was also very concerned to learn that the flu vaccine is suspended in mercury, a known neurotoxin - and this is what we are injecting into our children en masse? I've had the flu before. It's pretty awful. But I survived, and in my 28 years, have luckily only had it once. For those with health issues and compromised immune systems it may certainly be a consideration - but for those of us who would endure a week of gross symptoms and then get back to normal, I think it's worth a second thought.

Stephen Devoto said...

The CDC web site has extensive discussion about the safety of thimerosol, a mercury-based preservative which is used to prevent bacterial contamination of vaccines. Thimerosol-containing vaccines were injected into millions of children and adults, over a period of nearly 70 years. This large number is the pipe-dream of any clinical epidemiologist, and many of them have looked very rigorously (some might say desperately) for an association between thimerosol and adverse health or behavior consequences. None have succeeded.

Opponents of vaccination have claimed a link between thimerosol in childhood vaccines and the development of autism (and other disorders). However, thimerosol has not been used in childhood vaccines since 2001, and there has been no change in the rate of autism or other disorders attributed to thimerosol.

Karen discusses the murky, and surprisingly hard to find statistics about the risks of infecting a child if an adult does or does not have the vaccine. If indeed there is no evidence that a newborn is safer if an adult is vaccinated, this would be a reality-based reason for not getting the vaccine. The presence of the preservative thimerosol is not.

Below is an excerpt from the CDC website on thimerosol:
Three U.S. health agencies (The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH)) have reviewed the published research on thimerosal and found it to be a safe product to use in vaccines. Three independent organizations [The National Academy of Sciences’ Institute of Medicine, Advisory Committee on Immunization Practices (ACIP), and the American Academy of Pediatrics (AAP)] reviewed the published research and also found thimerosal to be a safe product to use in vaccines. The medical community supports the use of thimerosal in influenza vaccines to protect against potential bacterial contamination of multi-dose vials.

Danielle said...

I have a one month old baby, and asked all my close relatives who were visiting to get the vaccine. They did. This vaccine is part of the DTAP vaccine, which also prevents tetanus. Personally, I keep on top of my tetanus vaccine before I do any traveling, so to me this is a pretty routine shot to get.

I also did some research, but did not see anything mentioning fully vaccinated adults contracting pertussis. Was this for recently vaccinated adults? I did find many references to adults who had been vaccinated years ago contracting it, however. The shot wears off, which is why it was added to the tetanus shot. This was a case for the vaccine in my opinion.

Just because you are not feeling sick now, does not mean that you are not capable of transmitting pertussis. There is an incubation period of up to ten days, where you are contagious but not symptomatic. I was especially concerned about my relatives who would be flying or in otherwise close contact with large populations of people.

Note that it is possible to get the vaccine at the CVS minute clinic in Rocky Hill, which saves the hassle of making an appointment with your doctor. Additionally, as of October 1, pharmacies can give this vaccine (the same way that they give the flu shot). This is a recently changed law to combat the increasing rates of pertussis.

Rachel said...

An extensive discussion by the CDC does not provide me any comfort. Our government agencies have approved the use of many substances since their inception that we have later discovered to be harmful or certainly potentially so (one of which we drink everyday in our municipal water). I don't overestimate the ability of those with a financial investment in the continued widespread use of these vaccines to influence the recommendations we receive from agencies that are supposedly in place to protect us. My bottom line is that I don't need foreign substances pumped into my body to offset the small chance that I will contract a virus that I am very highly capable of surviving.