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 SoundsOfPertussis.com 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 CDC.gov 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 CDC.gov].

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.