As a parent, I have had first hand experience with pertussis. Whooping cough, when experienced by one of your children makes one thankful for the vaccines that we do have. Not vaccinating our children can have disastrous effects.
Very young children who cannot yet be vaccinated are put at risk when many choose to not vaccinate.
Vaccines are the best defense that we have against childhood illnesses that can and have devastated lives.
Considering that no vaccine is 100% safe, when it involves the life of your child, gambling is a scary prospect. DTP vaccination has not been without controversy but let’s consider these illnesses themselves. We are not discussing the common cold or even the flu, dangerous as it is in its own right. The diseases that we currently vaccinate against were the stuff that caused nightmares for our parents and grandparents. They would probably think us absolutely crazy to be giving up the opportunity to vaccinate against these illnesses that had an deadly impact on almost every family at one time.
I am sympathetic to parents who want the best for their children and truly are seeking out the best advice…I have none to offer. I can only offer counterbalance to the argument for or against.
In the U.S. immunization against pertussis, tetanus and diphtheria became commonplace in the late 1940’s.
[borrowing heavily from the CDC…]
Diphtheria
Prior to the introduction of vaccine, diphtheria was commonplace. In the 1920s there were an estimated 150,000 cases with 13,000 deaths reported annually. By 1945 the number of reported cases had dropped to 19,000. In the decade of the 70’s an average of 196 cases were reported annually. Between 1980 and 1995 a total of 41 cases of diphtheria were reported. Of these 41 cases 10% were fatal. Of the fatal cases all of them were unvaccinated children.
What is Diphtheria
Diphtheria is a highly contagious disease caused by bacteria. Corynebacterium diphtheria infects the nasopharynx but it can also infect the skin.
In the nasopharyngeal form of the illness the bacteria live in the nose, throat, and mouth of an infected person and the illness is spread to others mostly through respiratory secretions but less commonly through contact with skin lesions or through contact with contaminated objects such as used tissues. Asymptomatic carriers can also spread the bacteria and can be contagious for 2 to 4 weeks unless they are treated with antibiotics.
During the course of the illness the bacteria begin to produce toxins that damage cells, destroy tissues and can cause a membrane to form at the site of infection within 2 to 3 days of infection, usually at the nasopharynx. This membrane can grow large enough to obstruct breathing.
The toxins themselves can be absorbed into the bloodstream effecting the entire body. If enough of the toxins are absorbed the illness can cause inflammation of the heart muscle, inflammation of the nerves or groups of nerves causing pain, loss of reflexes or atrophy of muscles, coma, and death.
The overall death rate among those infected is 5-10%, rates of death among children under 5 is up to 20%. Those older than 40 years of age also experience death rates up to 20%.
Diphtheria cases in the United States 1940-2003
Tetanus
Tetanus is a nervous system disease caused by toxins produced by the spore forming bacteria, Clostridium tetani. Tetanus is not a contagious illness but without vaccination these commonplace bacteria that live in soil, dust, and animal feces can enter the body through breaks in the skin.
Once in the body, the bacteria then produces tetanus toxins which circulate throughout the body blocking nerve impulses which normally allow the muscles to relax.
Beginning with spasms in the jaw and neck which can be so severe that the infected person cannot swallow or will have trouble breathing.
The stiffness spreads throughout the body. Spasms can be so severe as to break bones. Up to 11% of all tetanus cases are fatal even with treatment. Tetanus can infect newborns through mothers who have not been vaccinated. This is a common problem in other areas of the world where tetanus vaccination is less commonplace. About 270,000 deaths per year are caused by neonatal tetanus.
Through vaccination tetanus cases have thankfully declined.
Tetanus cases from 1940 to 2003
Pertussis
click here: Watch this video
or this one
Pertussis (whooping cough) is a highly contagious disease caused by the gram negative bacteria, Bordatella pertussis. It is one of the leading causing of vaccine preventable deaths in children world-wide. The illness is spread by airborne droplets. Symptoms begin like the common cold but progresses to the severe cough noted in the videos above. An infected person has trouble eating, sleeping, drinking, and even breathing. This severe coughing can last for weeks and can lead to pneumonia, dehydration, weight loss, seizures, brain damage and death.
Reported cases of pertussis 1922-2004
In the news
North Carolina
Updated 5:25 PM
By: Johnny Chappell
CHAPEL HILL – Health officials confirmed another two cases of whooping cough at Estes Hills Elementary Tuesday afternoon, meaning a total of seven students have been infected with the disease.
Health officials are warning parents to be on alert. They said the seven infected students at the school were either related or had close contact with each other. Teachers sent home letters everyone who has had close contact with the children, and all of the school nurses are on alert looking for symptoms of coughing.
A vaccination for whooping cough, or pertussis, is required by the state for all children before going into kindergarten.
“Any vaccine is not 100 percent effective, so even though you’ve had the vaccine you still may be at risk,” Orange County Health Department Director Rosmary Summers said.
She said the highest risk groups are infants and the elderly.
“Those are the ones, who, if they got pertussis, would have a serious illness, perhaps would be hospitalized,” Summers said.
Health officials said family or friends who come into close contact with those affected are usually the only ones at risk, but parents should still keep a close watch out for symptoms.
“It’s a particular cough that you don’t have a pause in between. You just have to keep coughing, so you can barely catch your breath,” said Summers. “At the end of the cough, there’s sort of the classic ‘whoop’ or inhalation that gives you that strange sound.”
Summers warned that with the holidays ahead, it’s important to remember family members who may be at high risk.
an earlier report today stated….
CHAPEL HILL (WTVD) — Officials are warning about a possible outbreak of whooping cough in several counties.
Five cases were reported at Estes Hills Elementary School in Chapel Hill. Administrators are asking parents to keep a close eye on their children and watch for symptoms.
Pertussis is an acute bacterial infection of the respiratory tract that is caused by the organism Bordatella Pertussis. It is transmitted through close contact with an infected person’s respiratory droplets.
[read the rest of the report here]
Kansas
WICHITA, Kansas – Sedgwick County health officials are warning parents to be on the look-out for whooping cough.
The Sedgwick County Health Department has two suspected cases from students – one at Allison Middle School and the other at Northwest High School.
Officials say this is not an outbreak, but they just want to remind parents of the symptoms.
Whooping cough’s initial symptoms resemble a cold with the coughing intensifying in frequency, severity and regularity. There is often times a “whooping” sound as a person is breathing. Doctors recommend having your child vaccinated to prevent the illness.
Missouri
(St. Louis, MO) — An increase in whooping cough cases has officials reminding all Missourians to check on their latest vaccination for the disease.
While there are no reports so far this year in Greene County, it’s quite a different story in St. Louis County. Health officials there have reported 146 cases, compared to only eight last year.
Two other Eastern Missouri counties have also seen a spike.
The bacterial infection causes coughing with a high-pitched “whoop” sound and nausea.
Make sure you check with your doctor to make sure their vaccines are up-to-date. Health officials say you can get a TDAP shot, which has tetanus, pertussis and diphtheria.
Illinois
Barrington Area Unit District 220 has issued an alert to the community that four cases of pertussis have been reported in its schools.
Pertussis, commonly called whooping cough, has become more widespread in this year in Lake County, where health officials have reported 82 confirmed cases as of Nov. 21. That compares to 20 in 2007.
District 220 did not indicate which specific schools were affected, though the health department said about 60 percent of cases involved children 5 to 11.
Whooping cough can be highly contagious and can be similar to a common cold or flu, though can be serious is severe cases. Symptoms can include a cough lasting more than seven days and coughing fits. Anyone with symptoms should contact a physician.
Most area cases have been mild since most were in children who were vaccinated, authorities said.
Basic prevention includes hand washing with soapy water and coughing into a tissue or sleeve. Children should be reminded not to share drinks, eating utensils or lip balms.
District 220 is out of session until Monday for the Thanksgiving holiday.
By ERIC SCHELKOPF – eschelkopf@kcchronicle.com
Although Kane County has not experienced as many cases of whooping cough this year as other counties, health officials here are monitoring the situation.
So far this year, the county has had nine cases of the highly contagious disease, with the last case being diagnosed in September. The county had 14 cases last year.
In comparison, Winnebago County last week announced it has had 38 cases of whooping cough since the end of October, with 28 cases involving a private school.
“It is a real serious disease and we will keep an eye out for it,” said Tom Schlueter, public information officer for the Kane County Health Department.
[Read the rest of this report here]
Other states reporting in recently Nebraska, Minnesota, Kentucky, Pennsylvania, Ohio,…
Resources from the CDC:
Clinical Features
Highly communicable, vaccine-preventable disease that lasts for many weeks and is typically manifested in children with paroxysmal spasms of severe coughing, whooping, and posttussive vomiting.
Etiologic Agent
Bordetella pertussis, a gram-negative coccobacillus.
Incidence
This disease results in high morbidity and mortality in many countries every year. In the United States, 5000-7000 cases are reported each year. Incidence of pertussis has increased steadily since the 1980s. The incidence in 2002 was 3.01/100,000 when 8,296 cases of pertussis were reported.
Complications
Major complications are most common among infants and young children and include hypoxia, apnea, pneumonia, seizures, encephalopathy, and malnutrition. Young children can die from pertussis and 13 children died in the United States in 2003. Most deaths occur among unvaccinated children or children too young to be vaccinated.
Transmission
Occurs through direct contact with discharges from respiratory mucous membranes of infected persons.
Risk Groups
Children who are too young to be fully vaccinated and those who have not completed the primary vaccination series are at highest risk for severe illness. Like measles, pertussis is highly contagious with up to 90% of susceptible household contacts developing clinical disease following exposure to an index case. Adolescents and adults become susceptible when immunity wanes.
Surveillance
National reporting through the National Electronic Telecommunications System for Surveillance (NETSS) and through several Enhanced Surveillance Sites throughout the United States.
Trends
Pertussis is an endemic illness. In the United States epidemics occur every 3-5 years. The most recent epidemic occurred in 1996. Overall increase in cases since 1990, with disproportionate increase in adolescents and adults.
Challenges
Understanding pertussis pathogenesis and immunity; protecting infants from severe pertussis; control of pertussis outbreaks; diagnosing pertussis in a timely, accurate, and standardized fashion; understanding the true burden of disease in different age and socioeconomic groups; evaluating the impact of a licensed pertussis vaccine in persons > 14 years of age; evaluating the impact of acellular vaccines on prevention programs; and determining the prevalence of erythromycin-resistant B. pertussis.
Opportunities
Characterize strains using newly developed molecular typing methods (e.g., pulsed-field gel electrophoresis and gene-sequencing analysis) to elucidate epidemiology and virulence factors, examine isolates for antimicrobial susceptibility and to identify resistance mechanisms; study transmission of pertussis within populations (e.g., how adults/adolescents transmit the organism to others); study efficacy of acellular pertussis vaccines among persons > 14 years of age; study effectiveness of acellular pertussis vaccines to control outbreaks; apply/evaluate new diagnostic tests.
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