Pertussis is a bacterial illness caused by the Bordetella Pertussis. It can be a severe illness resulting in prolonged coughing spells that can last for many weeks but rarely causes death. It is most dangerous in children under the age of 12 months because they are not able to cough. The coughing spells can make it difficult for a person to eat, drink, and breathe. Because vomiting often occurs after a coughing spell (to rid the body of phlegm), persons may lose weight and become dehydrated. In infants, it can also cause pneumonia and in rare and severe cases, lead to brain damage, seizures and mental retardation.
Pertussis Death by Numbers
From the 17th century and up to the early 19th century, pertussis was considered a killer disease. Outbreaks during the 17th and 18th century were common in Europe. Outbreaks also were common in America and by the 1930s, 73% of all American children under the age of 10 were exposed to pertussis. (1) Before the first vaccine was introduced on a mass scale, death from pertussis had declined more than 75% by 1943. (2)
Before the Bordetella pertussis vaccine became available, the illness was a leading cause of death in infants, and nearly all children developed whooping cough. The vaccine itself cannot be credited with the decline in pertussis deaths. This was also when public sanitation systems were implemented, clean drinking water became available, better distribution of fresh fruits and vegetables and also the focus on personal hygiene was stressed. The death rates were high at the turn of the century until the 1920’s and then they began to steadily drop. Prior to the public improvements and the introduction of the vaccine150,000 and 260,000 cases of this infection were reported annually. In 1900 to 1920, up to 9,000 pertussis related deaths were reported. Even with the public sanitation improvements and the vaccine coverage at 75% - 80%, cases of pertussis have been increasing since the 1980s, with outbreaks every 3 to 5 years in the United States.
Infants 6 months old and younger with pertussis have the highest rate of hospitalization and death because they lack in natural immunity and they cannot cough out the thick phlegm. From 2000 through 2008, 181 persons died from the infection, with 166 of them less than 6 months old. As recently as 2010, the state of California suffered a pertussis “epidemic”, (epidemic- more cases than what would be considered normal based on previous cases). This could be happening due to a few different reasons. Pertussis runs in a 3-5 year cycle and there are outbreaks across the country regardless of the vaccine rate. Not all people have an appropriate immune reaction to the vaccine; vaccines do not result in immunity, more like immune system suppression. With this new outbreak, it is not the same strain that is in the vaccine. The bacteria have mutated and are called B Parapertussis. (3) It is a milder form of pertussis for most people.
Ironically in 2011, California saw no deaths from pertussis, for the first time in 20 years. The state of New Jersey has seen recent cases. Already for 2012, the CDC states that pertussis is being seen in at least a dozen states in the U.S. Still, the number of cases is much lower than in the pre-vaccine era.
Newer Attenuated Vaccine vs. First Pertussis Vaccine
The first pertussis vaccine was a whole-cell live vaccine and one of the most controversial vaccines in the childhood vaccine program. Reports of seizures, convulsions and many other neurological injuries were hitting the vaccine court system. For years, Dr. Mark Geier, geneticist and epidemiologist, reported to the CDC that the vaccine was causing major neurological problems. Other countries changed the pertussis vaccine but the United States continued to use the whole cell vaccine until 1998-2000. Dr. Geier was the physician that worked to attenuate the vaccine currently in use today, acellular DTaP. These vaccines are reportedly associated with fewer mild and moderate adverse reactions when compared with the older (whole-cell DTP) vaccines. There are currently 8 different pertussis (combination) vaccines approved on the market to date. Some are specific for adult use and some are for children.
(Attenuate- vaccine cultivated under conditions that disable their virulent properties, or which use closely related but less dangerous organisms to produce a broad immune response; however, some are bacterial in nature. They typically provoke more durable immunological responses and are the preferred type for healthy adults) (4).
Pertussis Around the World
During the 1970s, widespread concerns about the safety of the older pertussis vaccine led to a rapid fall in immunization levels in the United Kingdom. More than 100,000 cases and 36 deaths due to pertussis were reported during an epidemic in the mid-1970s. In Japan, pertussis vaccination coverage fell from 80 percent in 1974 to 20 percent in 1979. An epidemic occurred in 1979, resulted in more than 13,000 cases and 41 deaths. We cannot compare the death rates from the illness to the injuries caused by the vaccine. This data is not available but I believe that, based on the number of people who were compensated through the Vaccine Compensation System (VCS), the vaccine caused more death and harm than the pertussis illness. Unfortunately, these statistics do not take into consideration the number of deaths in these children who were previously vaccinated with the whole-cell vaccine.
While most cases of pertussis resulting in death are in infants less than 4 months of age, we can assume that these children are immune compromised or just not capable of fighting off the bacterial infection due to immaturity.
Pertussis outbreaks will occur around the world as it is a bacterial infection. Of those who died from it, it is difficult to know how many received a vaccine or other vaccines that may have contributed to the deaths. Reality, we are always going to have children who are born weaker and who will not withstand the various illnesses they get exposed to. The vaccine will not guarantee immunity and comes with its own risks. If you decide to take the vaccine, a booster is required every 5 years or so because it does not offer life-time immunity.
Diseases are continually adapting and mutating…we will never be able to avoid infectious illnesses! It makes much more sense to focus on building and supporting the immune system so that when exposed, we will react appropriately recover the way the human body was intended and build life-time immunity.
(1) Make an Informed Vaccine Decision, Parents Guide to Childhood Shots-Mayer Eisenstein, MD, JD, and MPH with Neil Z. Miller
(2) Neil Z. Miller, Death Rate and the Pertussis Vaccine
(3) JAMA, 1998 Whooping Cough Caused by Bordetella pertussis and Bordetella parapertussis in an Immunized Population ,Qiushui He, MD; Matti K. Viljanen, MD; Heikki Arvilommi, MD; Birgitta Aittanen; Jussi Mertsola, MD