The following is the first half of a two-part article on pertussis. Click here to read the second half of the article.
For the past decade, Americans have been subjected to dire warnings that B. pertussis whooping cough cases are on the rise and it is the fault of parents who don’t vaccinate their children.1 2 3 That myth actually goes back to the early 1980’s,4 when parents of DPT vaccine injured children in the U.S. were asking for a safer pertussis vaccine while, at the same time, discovering that whole cell pertussis vaccine in DPT shots did not prevent infection5 and vaccine immunity lasted for only two to five years.6 7
The same old excuse—“it’s the parent’s fault”—is being invoked again in the 21st century by forced vaccination proponents who want to eliminate vaccine exemptions, 8 9 10 11 just as another generation of parents are discovering that acellular pertussis vaccine in DTaP shots also does not prevent infection 12 13 14 and vaccine immunity is waning, lasting at best for two to five years.15 16 17
Time to Dispel Myths and Lies About Pertussis and Pertussis Vaccines
What’s old is new again. And it is time to dispel the myths and lies being told about pertussis and pertussis vaccines.
- FACT: Both the reactive whole cell DPT vaccine licensed 1949 and the less toxic acellular DTaP vaccine licensed in 1996 do not prevent infection or transmission, and only provide two to five years of temporary immunity at best;
- FACT : Millions of vaccinated children and adults are silently infected with pertussis in the U.S. every year and show few or no symptoms but spread whooping cough to vaccinated and unvaccinated children—without doctors identifying or reporting cases to the government;
- FACT : In response to mass pertussis vaccination campaigns beginning in the 1950s, the B. pertussis microbe evolved to evade both whole cell and acellular pertussis vaccines, creating new strains producing more toxin to suppress immune function and cause more serious disease.
Now, here is the rest of the story in more detail:
High Child Pertussis Vaccination Rates in U.S. for 35 Years
Child pertussis vaccination rates in the U.S. have remained very, very high for the past 35 years.18 Consistently, more than 94% of kindergarten children have had four to five pertussis-containing shots either in whole cell DPT or acellular DTaP vaccines.19 There is a 94% pertussis vaccination rate for children under 35 months old20 and, today, 88% of teenagers attending high school have gotten a sixth pertussis booster shot.21
That’s a lot of pertussis vaccination going on in America for a long time among children of all ages, many of whom are now adults in their 20s, 30s and 40s. So why are public health officials reporting that large numbers of fully vaccinated pre-schoolers in Florida,22 and fully vaccinated teenagers in California,23 and fully vaccinated sisters and brothers of newborn infants are spreading pertussis whooping cough—24even though most have gotten every pertussis shot recommended by the CDC?
Before we examine why the experts are fighting with each other about the answer to that question, let’s do a quick review of the history of pertussis and pertussis vaccine.
DPT Licensed in 1949 and DTaP in 1996 for U.S. Babies
B. pertussis whooping cough has been around since at least the 16th century, and it can be especially serious for babies who cannot breathe when the sticky mucous produced by the gram negative bacteria clogs their tiny airways.25 26 The first crude whole cell pertussis vaccine was licensed in 1914,27 but was not given widely to children until after 1949, when it was combined with diphtheria and tetanus vaccines into the DPT shot28 and used until 1996, when a less reactive DTaP vaccine was licensed in the U.S.29
By 2014, public health officials reported that 86% of the world’s children had gotten at least three pertussis shots,30 but estimate there are still about 16 million pertussis cases and 195,000 pertussis-related deaths every year globally.31
75% Drop in Pertussis Deaths Before DPT Licensed in 1949
But what about deaths in the U.S. from pertussis whooping cough?
In our country, deaths from pertussis infections dropped by more than 75% between 1922 and 1948, the yearbefore the DPT vaccine was licensed. In 1948, the mortality rate was less than 1 pertussis death per 100,000 persons and would never be higher than that again.32 33 In 2013, there were about 29,000 reported pertussis cases and 13 pertussis-related deaths in America, with nine of those deaths in infants under age one.34
However, reported numbers of pertussis cases do not match the total number of actual cases of pertussis that are happening in America. Most pertussis cases, like most vaccine reactions, are not being diagnosed or reported by doctors to the government.35 Public health officials admit they still don’t have reliable lab tests to measure pertussis immunity and can’t agree about how to diagnose pertussis when infected people, especially vaccinated people, show up in doctor’s offices with mild symptoms.36 37 38
Millions of U.S. Pertussis Cases in Vaccinated Persons Not Identified or Reported
But what public health officials have known for a long time—and do not publicly talk about—is that millions of vaccinated children and adults living in the U.S. get pertussis whooping cough and are never identified.39 40 41 42 That’s right: there are millions of pertussis infections going on in America among vaccinated people but doctors are not diagnosing or reporting them.
In fact, whether you or your child have been vaccinated or not, you can get a silent asymptomatic pertussis infection and transmit it to someone else without even knowing it. 43 44 45 That child or adult sitting next to you in the bus, classroom, movie theater or doctor’s office, who has a little cough or no cough at all, could be infected with B. pertussis whooping cough, even though he or she has gotten every federally recommended dose of pertussis vaccine.
1 MSNBC. Growing outbreaks of whooping cough raise health fears . July 28, 2010.
2 Brown M. Pertussis Outbreaks Hit West, Midwest–Again. Parents Refusal to Vaccinate Singled Out as Contributing Factor . American Academy of Family Physicians (AAFP) May 30, 2012.
3 Kerns J. Researchers: Vaccination Exemptions Linked to Increase in Whooping Cough Cases. MyNorthwest.com June 4, 2013.
4 Kotulak R. Vaccination Urged for Whooping Cough . Chicago Tribune Nov. 17, 1985.
5 Fine PEM, Clarkson JA. The Recurrence of Whooping Cough: Possible Implications for Assessment of Vaccine Efficacy. The Lancet 1982; 1(8273): 666-669.
6 Trollfors B. Bordetella pertussis whole cell vaccines–efficacy and toxicity . Acta paediatrica Scandinavia 1984; 73(4): 417-425.
7 Transcript (partial) of May 12, 1986 ACIP Meeting discussion of DPT risks and failures. Pgs. 34-37. NVIC.org.
8 Stadlin S, Bednarczyk RA, Omer SB. Medical Exemptions to School Immunization Requirements in the United States–Association of State Policies with Medical Exemption Rates (2004-2011). J Infect Dis Aug. 29, 2012.
9 Omer SB. How to Handle the Vaccine Skeptics. The New York Times Feb. 6, 2015.
10 Phadke VK, Bednarczyk RA, Salmon DA, Omer SB. Association Between Vaccine Refusal and Vaccine-Preventable Disease in the United States: A Review of Measles and Pertussis. JAMA 2016; 315(11): 1149-1158.
11 Rappaport L. Vaccine refusal tied to increased risk of measles and pertussis. Reuters Mar. 15, 2016.
12 Lavine J, Bjornstad O, de Blasio BF, Storsaeter J. Short-lived immunity against pertussis, age-specific routes of transmission, and the utility of a teenage booster vaccine. Vaccine 2012; 30(3): 544-551.
13 Cherry JD. Why Do Pertussis Vaccines Fail? Pediatrics 2012; 129(5).
14 Warfel JM, Zimmerman LI, Merkel TJ. Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model. Proc Natl Acad Sci USA. 2014; 111(2): 787–792
15 Misegades LK, Winter K, Harriman K et al. Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010. JAMA 2012; 308(20): 2126-2132.
16 Matthias J, Pritchard S, Martin SW et al. Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA. Emerging Infectious Diseases Jan. 15, 2016.
17 Klein NP, Bartless S, Fireman B, Baxter R.Waning Tdap Effectiveness in Adolescents. Pediatrics Feb. 3, 2016.
18 Hinman A, Orenstein WA, Schuchat A. Vaccine Preventable Diseases, Immunization and MMWR 1961-2011. MMWR Oct. 7, 2011; 60(04): 49-57.
19 CDC. Vaccination Coverage Among Children in Kindergarten–United States, 2014-15 School Year. Aug. 28, 2015: 64(33): 897-904.
20 CDC. National, State and Selected Local Area Vaccination Coverage Among Children Aged 19-36 Months–United States, 2014. Aug. 28, 2015: 64(33): 889-896.
21 CDC. National, Regional, State and Selected Local Area Vaccine Coverage Among Adolescents Aged 13 to 17 Years–United States, 2014. MMWR 2015; 64(29): 784-792.
22 Matthias J, Pritchard S, Martin SW et al. Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USA. Emerging Infectious Diseases Jan. 15, 2016.
23 Klein NP, Bartless S, Fireman B, Baxter R. Waning Tdap Effectiveness in Adolescents. Pediatrics Feb. 3, 2016.
24 Skoff TH, Kenyon C, Cocoros N et al. Sources of Infant Pertussis Infection in the United States. Pediatrics 2015; 136(4): 635-641.
25 Bart MJ, Harris SR, Advani A et al. Global Population Structure and Evolution of Bordetella pertussis and Their Relationship with Vaccination. MBio 2014; 5(2).
26 Kallonen T, He Q. Bordetella pertussis strain variation and evolution post vaccination. Expert Rev Vaccines 2009; 8(7): 863-875.
27 Institute of Medicine. Pertussis and Rubella Vaccines: A Brief Chronology (Appendix B, pp. 320) In: Adverse Effects of Pertussis and Rubella Vaccines. The National Academies Press 1991.
28 NIH. Historical Record of Vaccine Product Licensing Holders in the United States. (Table H-1). In: The Children’s Vaccine Initiative: Achieving the Vision. The National Academy of Sciences 1993.
29 CDC. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Mar. 28, 1997;46(RR-7):1–25
30 World Health Organization. Immunization Coverage (Global). WHO.int September 2015.
31 CDC. Pertussis in Other Countries. Sept. 8, 2015.
32 National Center for Health Statistics. U.S. Vital Statistics Mortality Data 1940-1949. Table 2–Death Rates for Selected Causes, Whooping Cough (All Races, Both Sexes) 1948 . Pg. 38.
33 Grove RD, Hetzel AM. Vital Statistics Rates in the United States 1940-1960. General Mortality (1921-1929), Section C, Table 65: Whooping Cough. Pg. 577. U.S. Public Health Service National Center for Health Statistics 1968.
34 CDC. 2013 Final Pertussis Surveillance Report. Aug. 15, 2014.
35 Bamberger ES, Srugo I. What is new in pertussis? Eur J Pediatr 2008; 167: 133-139.
36 Cherry JD. Why Do Pertussis Vaccines Fail? Pediatrics 2012; 129(5).
37 Zouari A, Smaoui H, Kechrid A. The diagnosis of pertussis: which method to choose? Crit Rev Microbiol 2012; 38(2): 111-121.
38 Van der Zee A, Schellekens JF, Mooi FR. Laboratory Diagnosis of Pertussis. Clin Microbiol Rev 2015; 28(4): 1005-10026.
39 Sutter RW, Cochi SL. Pertussis Hospitalizations and Mortality in the United States, 1985-1988: Evaluation of the Completeness of National Reporting. JAMA 1992; 267(3): 386-391.
40 Deville JG, Cherry JD, Christenson PD et al.Frequency of Unrecognized Bordetella pertussis Infections in Adults. Clin Infect Dis 1995; 12: 639-642
41 Cherry JD. The Epidemiology of Pertussis: A Comparison of the Epidemiology of the Disease Pertussis With the Epidemiology of Bordetella pertussis Infection. Pediatrics 2005; 115(5).
42 Ward JI, Cherry JD, Chang S et al. Efficacy of an Acellular Pertussis Vaccine among Adolescents and Adults. N Eng J Med 2005; 353(15): 1555-1563.
43 Long SS, Lischner HW et al. Serologic evidence of subclinical pertussis in immunized children. Pediatr Infect Dis 1990; 9(10): 700-705.
44 He Q, Viljanen MK, Nikkari S et al. Outcomes of Bordetella pertussis Infection in Different Age Groups in an Immunized Population. J Infect Dis 1994; 170: 873-877.
45 Zhang Q, Yin Z, Shao LH et al. Prevalence of asymptomatic Bordetella pertussis and Bordetella parapertussis infections among school children in China as determined by pooled real-time PCR: a cross-sectional study. Scand J Infect Dis 2014; 46(4): 280-287.