Hyponatremia and Central Pontine Myelinolysis

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Pertussis- Is there an increase and why?:

We are in the midst of an outbreak of Pertussis, and there is a lot of information pointing blame at those who have not been immunized or fully immunized. At first, that was what was widely believed to be the cause.

However, recently, it has become accepted that the pertussis vaccine is not as effective as an earlier version. There are a few theories as to why, but the medically accepted reason right now is the new formula that was introduced in the late 1990’s is not as effective as the original vaccine. The original vaccine contained whole cells of the bacteria. The new vaccine contains acellular components of the bacteria.

They changed the formula because there were serious side effects ranging from fever and malaise to meningitis. Frankly, there have been significantly more claims of reactions to the original (whole cell) vaccine, but those are the widely accepted reasons behind changing it.

Unfortunately, about 20% of the children that receive the whole cell vaccine experience mild side effects. About 0.1% of infants experience convulsions soon after receiving the vaccine and in a very small number of cases (1 in 150,000?) severe or irreversible brain damage may occur. In the absence of the disease in an immune population, parents have begun to wonder if the risk of vaccinating children outweighs the risk of the disease, and the value of the whole cell vaccine has been questioned. (http://textbookofbacteriology.net/themicrobialworld/pertussis.html)

From ABCnews.com: http://abcnews.go.com/Health/Wellness/whooping-cough-vaccine-effective-early-form-study-finds/story?id=16898211#.UHsvmMXA-8A

The original vaccine, which contained a small amount of inactivated whole bacteria, was a crude form that brought with it side effects like fever and swelling at the injection site, but it was considered lifelong lasting at preventing the disease. In the late 1990s, it was substituted for a so-called cleaner vaccine that only used small particles of the bacteria and was considered safer but might not be as effective long term.

According to an article published in JAMA– (http://jama.jamanetwork.com/article.aspx?articleid=1362036), the vaccination for pertussis is not effective:

To assess clinical, epidemiologic, and laboratory factors associated with this increase, all pertussis cases reported during January 1–June 16, 2012, were reviewed. Consistent with national trends, high rates of pertussis were observed among infants aged <1 year and children aged 10 years. However, the incidence in adolescents aged 13–14 years also was increased, despite high rates of vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, suggesting early waning of immunity.

The following article is in accordance to the belief of the vaccine not being as effective, according to an article in the Oxford Journals, Clinical Infectious Disease: (http://cid.oxfordjournals.org/content/early/2012/03/13/cid.cis287.short).

We identified 171 cases of clinical pertussis; 132 in pediatric patients. There was a notable increase in cases in patients aged 8-12. The rate of testing peaked in infants, but remained relatively constant until age 12. The rate of positive tests was low for ages zero to six, and increased in preadolescents, peaking at age 12. Vaccination rates of PCR positive preadolescents were approximately equal to that of controls. Vaccine Effectiveness was 41%, 24%, 79%, for ages 2-7, 8-12, 13-18, respectively.

Conclusions: Our data suggests that the current schedule of acellular pertussis vaccine doses is insufficient to prevent outbreaks of pertussis. We noted a markedly increased rate of disease from age 8 through 12, proportionate to the interval since the last scheduled vaccine. Stable rates of testing ruled out selection bias. The possibility of earlier or more numerous booster doses of acellular pertussis vaccine either as part of routine immunization or for outbreak control should be entertained.

So the question starts with, does the vaccine really work? And it is not certain if it does. If we use the data from above Oxford Journal article, the effectiveness of the vaccine in ages 2-7 was 41%, ages 8-12 only 24%, and ages 13-18 it was 79%.

Frankly, I don’t think any of those statistics are promising considering the severity of the infection.

According to the National Vaccine Information Center, there is also evidence that the vaccine has caused pertussis to mutate so that the vaccine does not work effectively:

There is also some evidence that B. pertussis bacteria may have evolved to become vaccine resistant. (http://www.nvic.org/vaccines-and-diseases/Whooping-Cough.aspx)

The idea that there was a mutation in reaction to the vaccine was published in a research article by Dr. Fritz Mooi. Dr. Mooi has studied Bordetella Pertussis for over 15 years and is world renowned as an expert on Pertussis: (http://www.ncbi.nlm.nih.gov/pubmed/19879977):

The etiologic agent of pertussis, Bordetella pertussis, is extremely monomorphic and its ability to persist in the face of intensive vaccination is intriguing. Numerous studies have shown that B. pertussis populations changed after the introduction of vaccination suggesting adaptation. These adaptations did not involve the acquisition of novel genes but small genetic changes, mainly SNPs, and occurred in successive steps in a period of 40 years. The earliest adaptations resulted in antigenic divergence with vaccine strains. More recently, strains emerged with increased pertussis toxin (Ptx) production. Here I argue that the resurgence of pertussis is the compound effect of pathogen adaptation and waning immunity.

The other consideration is that there are different types of pertussis, and the vaccine is only targeting one type of Bordetella bacteria, Bordetella pertussis.  According to an article published in JAMA: (http://jama.jamanetwork.com/article.aspx?articleid=1150090)

An unusual 2010 outbreak of whooping cough in Ohio that disproportionately affected adolescents led disease hunters from the US Centers for Disease Control and Prevention (CDC) to the surprising discovery that about a third of the cases were caused by infection with Bordetella holmesii and not Bordetella pertussis, the usual isolate among individuals with the characteristic symptoms of whooping cough.

There are other forms of Bordetella that cause whooping cough beside Bordetella holmesii. According to the National Vaccine Information Center (http://www.nvic.org/vaccines-and-diseases/Whooping-Cough.aspx):

There is another Bordetella pertussis whooping cough disease called B. parapertussis. Symptoms of B. parapertussis whooping cough can look identical to B, pertussis whooping cough but they are usually milder. B, parapertussis is increasing in the U.S. and other countries, which have had high pertussis vaccination rates for few decades. There are estimates that perhaps up to 30 percent of whooping cough disease in highly vaccinated populations may be  caused by B. parapertussis organisms.

It is possible to have both B. pertussis and B. parapertussis infections at the same time. Parapertussis is often milder than B. pertussis but can also involve serious complications which lead to pneumonia and death.

Pertussis vaccines widely used around the world do not protect against parapertussis. There is no vaccine for parapertussis.

Finally, is there an actual increase at all?

Right now, there is a LOT of publicity decreeing an outbreak, and you have people taking sides of who is to blame. You have people saying that it is being caused by the vaccine itself. You have people stating it’s from vaccinations not working or that it’s because some people aren’t getting vaccinations. Some people believe that the vaccines have caused mutations in the bacteria, and others believe that the vaccinations aren’t working because of the mutations in the bacteria. The most intriguing idea that I found is a belief that there hasn’t been any increase at ALL.

This final group that I’m researching believes that the number of people getting pertussis hasn’t increased, but the methods and standards for “classifying” a person as having pertussis has changed.

Previously, in order to be diagnosed with pertussis, a person had to have a persistent cough for more than 3 weeks AND a positive test for pertussis in order to have a “confirmed” case of pertussis. The CDC changed their definition and now states that a person only has to have the cough for 2 weeks AND a positive test for pertussis.

There have also been more defined symptoms for having pertussis. This makes it more likely for a physician who might not have considered it as being pertussis to now consider and test for it.

Regardless of these changes, it is also firmly accepted that for every reported and confirmed case of pertussis there are two or three cases that still go unreported.

I found this to be true in the case of my family.

When the test was positive, I thought, boy they’re going to want to notify EVERYONE (my son was sick first, and he went to school the entire time), but when the community health department called, I was told that even though my daughter had the positive test, they would not consider her as to having it because she has only had the cough for 10 days. Further, they were not going to “confirm” my son as having it even though he’s had his cough for 4 weeks because he did not have the positive test.

I was shocked! There weren’t going to be any notifications at all. I found this to be incredulous. The community health representative told me that if I took my son back to get tested, and he had a positive test than they would submit the confirmation, and if I called them back to report that my daughter still had her cough after 14 days, they would confirm her case too.

Why should this matter?

My children exposed a significant number of people while they were unknowingly contagious, so I approached their doctor to get the lab work done, but found out that she did not feel that it was necessary. AND it is not necessary for them. They don’t need the confirmation. They are being treated, but it is going unreported and therefore no one else will get the notice. The people that they exposed will not know to watch out for the illness.

I tried to address those concerns with their doctor, and she said it didn’t matter because as long as the people that they’ve had contact with have had their vaccinations, they won’t get it. I tried to express that I had found information to the contrary and even representatives from the CDC were stating that the vaccination is not as effective as it had been previously.  She felt I was wrong.

Frankly, it doesn’t matter to me what she thinks of me, it’s the fact that she is treating other people and if she doesn’t understand the importance of having the illness reported, then I’m at a loss. She  felt that we should just contact everyone that we’ve been in contact with over the past few weeks, but it simply isn’t as simple as that. My son plays for both JV and Varsity football. He is in contact with 100’s of people each week. We went to a MAJOR amusement park for two weekends while they were sick. There is no way to contact everyone that they’ve exposed, especially without the help of the community health department.

Again, she also believes that other people won’t need to worry about it because they’ve been vaccinated (I shared this belief prior to a week ago), but now I know that might not be 100% true.

She wasn’t the only local doctor who feels this way. I took my children back to the local children’s hospital yesterday, and the nurse that was taking care of them didn’t understand the need for testing and agreed with my doctor. As long as they were being treated, what’s it matter?

Our babysitter has been exposed over the past few weeks, and she started getting sick this week. Her father wasn’t going to do anything about it. Since she is 18 (and fully vaccinated), we took her to her doctor, and he treated her but did not run the testing to see if she had it. The doctor felt that she probably did have it, but he felt that testing or reporting of it was unnecessary.

Granted, the information in this post is new. It just gained major media attention in September that there are more reported cases since the 1950’s AND that those who have been vaccinated are getting ill too, but it is mind BLOWING to think that the local medical community does not understand why testing and reporting it is necessary.

That is the reason, I am writing about it now. I feel it fundamentally important that if you believe you have pertussis, than you need to get treated ASAP. You need to quarantine yourself until you’ve been on antibiotics for at least 5 days. You need to push for getting the testing done and have it reported to your local health department, and PLEASE do not think that just because you’ve been vaccinated (even fully vaccinated) that you don’t have it. Especially get tested if you find out that someone you know has been diagnosed with it and then you start to develop symptoms.

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