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Pertussis (Whooping Cough)

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Sick  Baby

Pertussis or whooping cough is said to be a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe.  A deep “whooping” sound is often heard when the patient tries to take a breath.
Initial symptoms, similar to the common cold, usually develop about a week after exposure to the bacteria.

Severe episodes of coughing start about 10 to 12 days later. In children, the coughing often ends with a “whoop” noise. The sound is produced when the patient tries to take a breath. The whoop noise is rare in patients under 6 months of age and in adults.

Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells are common.

Other pertussis symptoms include:

  • Runny nose
  • Slight fever (102 °F or lower)
  • Diarrhea

Initial symptoms are those of a common cold: runny nose, sneezing, listlessness, loss of appetite, some tearing in the eyes, and sometimes a mild fever. As the disease progresses the person develops a severe cough at night, which later appears during the day as well. Within a week to ten days after the first symptoms the cough may become paroxysmal. The child may cough a dozen times with each breath, each coughing bout ending with a ‘whooping’ intake of breath. Young infants and adults often do not display the classic ‘whoop’ when coughing.

Standard medical viewpoint
Since introduction of whooping cough vaccine deaths have reduced dramatically, and the disease has come under control.

The other side

Australia is currently experiencing extremely high levels of reported whooping cough. This situation has continued for a decade and has, at times, seen the reported rate of whooping cough reach levels similar to those recorded prior to mass vaccination in 1953, and has culminated in nearly 40,000 cases reported in 2011. Ironically, this increased level of reported illness has occurred during the same period that vaccination for the disease has increased substantially. In the past five years in Australia, national reporting rates were:

Year       Rate (per 100,000)
2009    139
2010    158
2011     173
2012    106
2013     54
(source: National Notifiable Diseases Surveillance System, Australian Government, Dept of Health https://www9.health.gov.au/cda/source/cda-index.cfm )

By contrast, the last national rates collected before mass vaccination commenced were as follows:

Year       Rate (per 100,000)
1944     87
1945     289
1946     41
1947     3
1948     167
(source: Notifiable diseases surveillance, 1917 to 1991, Australian Government, Dept of Health https://www.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-annlrpt-oz_dis19_91.htm-copy3 )

If you’re quick with a calculator you’ll discover that the average rate from 2009 – 2013 was actually slightly higher than that in the last five years recorded before mass vaccination started. It must be borne in mind, however, that notification rates are notoriously poor indicators of actual disease rates. Changes in habits, changes in disease definitions, and prompting from from health officials all contribute to varying patterns of reporting, and therefore render the rates incomparable over time. Mortality (deaths) is a much more stable indicator of actual disease trends.

Below are Pertussis notifications in Australia, from 1991 to early 2018 (click to enlarge, hit return arrow to come back here).

Source: Notifications of a selected disease by month and year, 1991 to present

A new strain?
Since the late 1980s, researchers around the world have reported on the emergence of a new strain of pertussis bacteria which is different from the type contained in the vaccine. Not only does this mis-match in bacteria mean that the vaccine can’t protect against the most commonly-found type of bacteria in the community (84% of all reported pertussis cases in Australia are reportedly associated with the newer strain), but it is a more virulent bacteria as well, causing more serious symptoms and leading to the first deaths in children in over 10 years.

To add insult to injury, not only is the whooping cough vaccine not able to protect against this newer, more dangerous strain, but mass use of vaccination may have led to its emergence in much the same way as overuse of antibiotics has led to the emergence of more dangerous strains of bacteria.

The history of Whooping Cough in Australia

whooping_cough

The graph above shows deaths from whooping cough from 1870 to 1970 in Australia. As you can see, by the time mass vaccination commenced in 1953 with the lincencing of DPT vaccine, deaths from this disease had already declined by roughly 95%. One thing is clear: vaccination played little, if any, role in the decline in deaths from the disease. It simply wasn’t around for the vast bulk of that decline. Whatever part it may have played in the tail-end 5-10% is a matter for speculation.

The next graph zooms in with a yearly plot of the latter 50 years of the period plotted above, and focusing on the under-5 years age group.

Whooping_cough_under5

About the Acellular Pertussis vaccine

More than 10 years ago, we in Australia were told that the whole-cell pertussis or whooping cough vaccine which we had used here since the 1930’s and which was ‘perfectly safe’, was being gradually replaced by another type of ‘even safer’ acellular vaccine.

The technology used to produce acellular pertussis vaccines had been used in Japan since 1981 but, since these vaccines were more expensive to produce and purchase, we here in Australia did not have access to them until almost 20 years later.

Unfortunately, whilst there is no doubt that for short-term side effects such as fever and crying, the newer acellular vaccines cause fewer reactions, when it comes to the long-term effects such as shock/collapse or convulsions, there is no difference at all. In fact, when we look at severe swelling at the injection site which sometimes requires surgery and massive loss of tissue, the acellular vaccines are far worse than the whole cell shots ever were (Pertussis for Australians, 2006). This type of reaction was the reason why the 18-month booster was removed from the vaccination schedule and we went from 5 shots of the triple antigen prior to school entry to 4 shots at 2, 4 and 6 months and then, between the ages of 4 and 5.

Pertussis vaccine is given in combination with tetanus and diphtheria. Newer pertussis vaccines such as the Infanrix Hexa (data sheet below) contain up to 6 separate vaccines in one needle. They may be administered with up to 3 other vaccines at one time, meaning that children can receive 9 vaccines in one visit.

Vaccine side effects

According to the US VAERS (Vaccine Adverse Events Reporting System), as of the 1st of April, 2012, there had been 130,448 reactions reported to a vaccine containing either diphtheria, tetanus or pertussis toxin. 2,464 of these involved life-threatening reactions of which 2,333 of the children or adults died. 11,498 of those who were reported as reacting to this vaccine had not recovered at the time of the report and may have had life-long-disabilities as a result.

Like Australia, VAERS uses a ‘passive’ adverse reaction reporting system which means that they admit to only collecting between 1 and 10% of all reactions. Therefore, the figures above are likely to represent only a small percentage of the actual damage caused by these vaccines.

Extra information

Resurgence of Whooping Cough May Owe to Vaccine’s Inability to Prevent Infections

The startling global resurgence of pertussis, or whooping cough, in recent years can largely be attributed to the immunological failures of acellular vaccines, School of Public Health researchers argue in a new journal article.

The article, published in F1000 Research, points to the differences in mucosal immunity between whole-cell pertussis (wP) vaccines and the newer acellular pertussis (aP) vaccines, first introduced in the 1990s, as playing a pivotal role in the resurgence of the disease.

“This disease is back because we didn’t really understand how our immune defenses against whooping cough worked, and did not understand how the vaccines needed to work to prevent it,” said Christopher J. Gill, associate professor of global health and lead author of the article. “Instead we layered assumptions upon assumptions, and now find ourselves in the uncomfortable position of admitting that we may made some crucial errors. This is definitely not where we thought we’d be in 2017.”

https://www.bu.edu/sph/2017/09/21/resurgence-of-whooping-cough-may-owe-to-vaccines-inability-to-prevent-infections/

 Whooping cough increase related to current vaccine

The move to an artificially created vaccine for whooping cough is behind an increase in cases of the deadly disease in the US, a new study suggests.

http://www.abc.net.au/science/articles/2015/04/24/4222316.htm

Whooping cough resurgence due to vaccinated people not knowing they’re infectious?

“Building on that result, Althouse and Scarpino used whooping cough case counts from the CDC, genomic data on the pertussis bacteria, and a detailed epidemiological model of whooping cough transmission to conclude that acellular vaccines may well have contributed to — even exacerbated — the recent pertussis outbreak by allowing infected individuals without symptoms to unknowingly spread pertussis multiple times in their lifetimes.

‘There could be millions of people out there with just a minor cough or no cough spreading this potentially fatal disease without knowing it,’ said Althouse. ‘The public health community should act now to better assess the true burden of pertussis infection.”

“Their results also suggest that a practice called cocooning, where mothers, fathers, and siblings are vaccinated to protect newborns, isn’t effective. ‘It just doesn’t work, because even if you get the acellular vaccine you can still become infected and can still transmit. So that baby is not protected,’ Althouse says.”

http://www.sciencedaily.com/releases/2015/06/150624071018.htm

http://www.biomedcentral.com/1741-7015/13/146

Nosocomial pertussis infection of infants: still a risk in 2009

Abstract

The Sydney West Centre for Population Health investigated a confirmed pertussis infection in a health care worker on a maternity ward and identified pertussis infection in 4 neonates cared for by this case. This report describes the public health intervention to identify and prevent further cases. Of the 4 neonates, three were laboratory-confirmed cases and one was diagnosed on clinical grounds alone. All were cared for by the infected worker during only one shift and developed symptoms six to 16 days afterwards. No other possible source of infection was identified. This investigation highlights the need to maintain awareness, particularly amongst staff working with neonates, that pertussis infection can arise despite complete vaccination. Thus it is important to investigate new coughing illnesses and exclude symptomatic staff from contact with neonates until pertussis infection is excluded or effectively treated. The burden on the health system arising from a pertussis infection in a health care worker in a high-risk setting is also described with the hospitalisation of 4 infants, and prophylactic antibiotics given to 73 new mothers, infants and health care workers. Commun Dis Intell 2010;34(4):440–443.

http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3404e.htm

This research suggests that although individuals immunized with an acellular pertussis vaccine may be protected from disease, they may still become infected with the bacteria without always getting sick and are able to spread infection to others, including young infants who are susceptible to pertussis disease.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm376937.htm

Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model.

Warfel JM1, Zimmerman LI, Merkel TJ.

Author information

Abstract

Pertussis is a highly contagious respiratory illness caused by the bacterial pathogen Bordetella pertussis. Pertussis rates in the United States have been rising and reached a 50-y high of 42,000 cases in 2012. Although pertussis resurgence is not completely understood, we hypothesize that current acellular pertussis (aP) vaccines fail to prevent colonization and transmission. To test our hypothesis, infant baboons were vaccinated at 2, 4, and 6 mo of age with aP or whole-cell pertussis (wP) vaccines and challenged with B. pertussis at 7 mo. Infection was followed by quantifying colonization in nasopharyngeal washes and monitoring leukocytosis and symptoms. Baboons vaccinated with aP were protected from severe pertussis-associated symptoms but not from colonization, did not clear the infection faster than naïve animals, and readily transmitted B. pertussis to unvaccinated contacts. Vaccination with wP induced a more rapid clearance compared with naïve and aP-vaccinated animals. By comparison, previously infected animals were not colonized upon secondary infection. Although all vaccinated and previously infected animals had robust serum antibody responses, we found key differences in T-cell immunity. Previously infected animals and wP-vaccinated animals possess strong B. pertussis-specific T helper 17 (Th17) memory and Th1 memory, whereas aP vaccination induced a Th1/Th2 response instead. The observation that aP, which induces an immune response mismatched to that induced by natural infection, fails to prevent colonization or transmission provides a plausible explanation for the resurgence of pertussis and suggests that optimal control of pertussis will require the development of improved vaccines.

https://www.ncbi.nlm.nih.gov/pubmed/24277828

Evolution of whooping cough bacterium could reduce vaccine effectiveness

“The bacterium that causes whooping cough, Bordetella pertussis, has changed – most likely in response to the vaccine used to prevent the disease – with a possible reduced effectiveness of the vaccine as a result, a new study shows.”

http://newsroom.unsw.edu.au/news/science/evolution-whooping-cough-bacterium-could-reduce-vaccine-effectiveness

Whooping cough beats vaccine

The strains have “swept across Australia during the epidemic period” according to Ruiting Lan, from the school of biotechnology and biomolecular sciences. More than 13,000 whooping cough cases were diagnosed in 2011 – an all-time high.

The Children’s Hospital at Westmead treated 76 children for whooping cough in 2011, up from 47 the previous year. The Sydney Children’s Hospital treated 34 children in 2011, up from 16 the previous year.

An acellular vaccine – introduced in Australia in 1997 after concerns about side-effects from the previous whole cell version – appeared to have promoted the spread of these variants, Dr Lan said, which overseas authorities had linked to “higher virulence on the basis of hospitalisation and case mortality data”.

http://www.smh.com.au/national/health/whooping-cough-beats-vaccine-20120320-1vibp.html#ixzz2UqBYhk6H

Sharp rise in cases of new strain of whooping cough

21 March 2012

Australia’s prolonged whooping cough epidemic has entered a disturbing new phase, with a study showing a new strain or genotype capable of evading the vaccine may be responsible for the sharp rise in the number of cases.

A team of Australian scientists, led by the University of New South Wales (UNSW), believe this emerging new genotype (called prn2-ptxP3) of the Bordetella pertussis bacterium may be evading the protective effects of the current acellular vaccine (ACV), and increasing the incidence of the potentially fatal respiratory illness, according to the study published in The Journal of Infectious Diseases.

“The genotype was responsible for 31 percent of cases in the 10 years before the epidemic, and that’s now jumped to 84 percent – a nearly three-fold increase, indicating it has gained a selective advantage under the current vaccination regime.”

http://newsroom.unsw.edu.au/news/health/sharp-rise-cases-new-strain-whooping-cough

The study, published in Emerging Infectious Disease, analysed 320 samples of Bordetella pertussis bacteria from patients with whooping cough from 2008 to 2012, with the proportion of pertactin-free bacteria jumping from 5 per cent in 2008 to 78 per cent in 2012.

Lead author Connie Lam said the “huge increase” in mutated bacteria, which has also been found in the US and France, was unexpected.

“The fact that they have arisen independently in different countries suggests it’s a response to the vaccine,” said Ms Lam, of the University of NSW School of Biotechnology and Biomolecular Sciences.

“It could also mean that these pertactin-free strains have gained a selective advantage over other bacteria, making it less obvious for the body to find and destroy.”

http://www.smh.com.au/national/health/whooping-cough-vaccine-loses-its-effectiveness-20140414-36np3.html

Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

http://www.ncbi.nlm.nih.gov/pubmed/?term=24277828

Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children

http://www.nejm.org/doi/full/10.1056/NEJMoa1200850?query=featured_home&#t=articleDiscussion

Study: Whooping cough outbreak linked to vaccinated children

http://digitaljournal.com/article/323187

Why Whooping Cough Is Rising Despite a New Vaccine

http://www.webmd.com/children/vaccines/features/whooping-cough-rising-despite-new-vaccine

Acellular pertussis vaccination enhances B. parapertussis colonization

http://www.cidd.psu.edu/research/synopses/acellular-vaccine-enhancement-b.-parapertussis

Immunized People Getting Whooping Cough, Experts Spar Over New Strain

http://www.kpbs.org/news/2010/dec/14/immunized-people-getting-whooping-cough-experts-sp/

Study: Whooping cough vaccination fades in 3 years

http://news.yahoo.com/study-whooping-cough-vaccination-fades-3-years-150528753.html

These are the vaccines used for Pertussis in Australia
Infanrix DTPa vaccine is a sterile suspension which contains diphtheria toxoid, tetanus toxoid and three purified antigens of Bordetella pertussis pertussis toxoid (PT), filamentous haemagglutinin (FHA) and pertactin (PRN)] adsorbed onto aluminium hydroxide.
Tripacel vaccine – Component Pertussis Vaccine Combined with Diphtheria and Tetanus Toxoids Adsorbed
Infanrix hexa Combined Diphtheria-Tetanus-acellular Pertussis (DTPa), Hepatitis B, Poliovirus and
Haemophilus influenzae type b vaccine
Boostrix vaccine – Combined diphtheria-tetanus-acellular pertussis (dTpa) vaccine
Infanrix IPV vaccine is a combined diphtheria, tetanus, acellular pertussis (DTPa) and inactivated poliovirus vaccine.
Quadracel Pertussis Vaccine-Acellular and Diphtheria and Tetanus Toxoids (Adsorbed) Combined with
Inactivated Poliovirus Types 1, 2 and 3 (MRC-5 Cell)

DATA SHEETS

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