One of the most popular talks I give is on the subject of vaccination. With so many scare tactics, misconstrued facts and anecdotal stories whirling around, finding accurate information about the risks and benefits of vaccination proves to be difficult at best. Now parents have an additional concern – there is a pertussis (whopping cough) “epidemic” in California, and if it continues, experts say it could be the worst in over 50 years. (The first vaccine was introduced in the 1930s and the vaccine was widely used by the 1940s, so this does not take us back to the pre-vaccine era, but does come close.) As of June 15, 910 cases have been confirmed and another 600 have been suspected – though as you will see, this could be a dramatic underestimation.

The emerging epidemic, assuming it reaches those proportions, has parents reevaluating their vaccine decisions, and is adding confusion to the already cloudy subject. What is causing this? Should we get additional vaccines? Is this caused by the anti-vaccine crowd? etc, etc, etc… Like anything, the story goes much deeper and is much more complex than any simple answer can provide.

Here are some pertussis facts:

Pertussis is the name of a Gram negative bacterium (Bordetella pertussis) that causes the disease commonly known as whooping cough. Whooping cough is a very complex illness – and highly misunderstood, even by many health care professionals. It begins as a seemingly benign cold, and is typically ignored at first. During this time, the individual experiences sniffling, sneezing and other cold-like symptoms for approximately 7-10 days. Beneath the surface, the pertussis bacteria are multiplying in the respiratory tract, where they are attached to the cilia that line bronchial tubes. As they do so, they produce toxins that contribute to damage within the respiratory tract. This is known as the first stage of the disease. During this stage, certain antibiotics can successfully destroy the bacteria, reducing the amount of damage that occurs. This is also the stage when the illness is most transmittable, and when diagnostic tests are most accurate – because the bacteria are active within the body. Remember though, this is also the stage that is commonly confused with a routine cold or virus – and is therefore usually ignored.

The second stage begins after the cold symptoms subside, after the damage has built up within the respiratory tract. It generally takes two weeks for the cough to reach this stage fully, as it progresses slowly, based on the harm from the bacteria. While the system is complex, essentially the cilia have been somewhat paralyzed, if not destroyed by the toxins, which also can constrict bronchial tubes, and this can hinder normal respiratory function. The individual will feel fine throughout the day – plenty of energy, no aching and no real complaints – until a coughing episode strikes. When the individual begins to cough, the damaged respiratory tract cannot react as it typically does, and the coughing continues for up to 90-120 seconds at a time. This hinders breathing so the episodes end in a big inhalation of air, which is often so strong that it makes a whooping sound, hence the name. In older children or adults, this might merely seem to be an annoyance, but in small babies or susceptible individuals, the lack of oxygen can become problematic, and even life threatening. Many individuals also vomit after the episodes because of the gagging it causes. Infants and the elderly are generally hospitalized to enhance the oxygen intake and hopefully prevent harm from the lack of oxygen during the episodes. These episodes can occur anywhere from 2-50 times per day. Unless they inhibit sleep, the individual is usually able to continue normal functioning between episodes, as though nothing was happening. In other words, in between episodes, there are no symptoms and the individual feels and appears to be just fine. This phase can linger for several months, though the number of episodes diminish over time.

It is important to realize that the symptoms experienced during this time are not related to a current bacterial infection – they are the result of the damage that occurred during the initial two to three week infection. Antibiotics are seldom helpful during this time and the risks often outweigh any benefits. The coughing episodes will continue until the body has healed itself from the damage caused by the infection and this will vary from individual to individual. (However, antibiotics might be beneficial for the sole purpose of preventing contamination – especially for those that work with pregnant mothers, young children or with other at-risk population groups. Any antibiotic use should be carefully considered in light of the emergence of resistant strains and the negative effects of depleting one’s protective bacteria stores.)

When these children visit the doctor, they appear to be perfectly healthy – unless they happen to get lucky and have an episode in the doctor’s office. Upon examination, there are no visible symptoms, even the lungs sound normal. The coughing episodes are more likely to occur at night, so it is not uncommon for an individual to go throughout the entire day with no coughing episodes – making the disease extremely difficult to identify. Added into this confusion is the fact that most individuals believe whooping cough is an unlikely diagnosis and care providers usually have to be persuaded to perform the testing, which has an extremely high false negative rate, and is rarely accurate if administered after the first two to three weeks. Suddenly it is easy to see how pertussis can quickly spread throughout a community.

Furthermore, the vaccines (with a full course) are roughly 60-80% effective, depending on the study cited, and it is not long lasting, requiring boosters that are rarely received, so vaccinated individuals can still easily get pertussis. Yet, this fact is rarely communicated, and many have the false assumption that they are not at risk for pertussis based upon their vaccination status. With the relatively mild symptoms, it is easily confused (by individuals and practitioners) for a persistent cough, asthma or even a lingering case of croup. So, in plain terms, we have vaccinated individuals with undiagnosed pertussis walking around our communities, unaware of the illness they are passing along to others. (A previously documented outbreak occurred in an elementary school where vaccination status was quite high, so while vaccines can reduce the risks, they don’t come close to providing complete protection, especially during outbreaks.) To complicate the issue, vaccination is not without risk to young children as some studies have linked it with up to an 11 fold increase in asthma when compared to non vaccinated individuals. However, to promote herd immunity, adults are often able to tolerate the vaccine (booster) much better. The acellular vaccine does not contain mercury and is recommended by more conservative physicians for children near 24 months of age, if not older. (The routine schedule is 2,4 and 6 months of age.) (side note: Vintage Remedies does not promote any specifics on when or if an anyone should be vaccinated, as it is a deeply personal decision that should be undertaken on an individual basis. The risk-benefit analysis will vary from family to family – and individual to individual, so this is something best undertaken with careful research and consideration.)

Pertussis can lead to complications, though many cases go completely undiagnosed. Roughly 1 in 100 individuals develop pneumonia. However, young infants are at extremely high risk as they are not able to withstand the coughing episodes. Approximately 80% of infants (under 6 month) require hospitalization and the mortality rate is significantly greater among infants than any other people group. However, vaccination, even with a typical schedule,  is not completed until 6 months – and is not initiated until 2 months. Yet, this age is the most at risk (not due to vaccinated status, but due to size and physical maturity) so prevention is the best form of protection for these little ones that are most susceptible. In the current outbreak, all deaths occurred in infants under 3 months.

Some important pertussis numbers:

• Only about 50% of individuals experience the “whoop” associated with pertussis. It is entirely possible to have pertussis and never whoop.
• Pertussis generally lasts anywhere from 3 weeks to 3 months. It has been called the “100 day cough” – average duration is 6-8 weeks.
• It is most contagious during the first two to three weeks, when the cough seems benign – it is rarely transmitted after the classic symptoms develop.
• It is very rare to obtain a positive culture after the first two to three weeks, so a negative culture does not rule out pertussis.

Due to the difficulty in diagnosing pertussis, some experts have suggested that the actual rates are up to 10 times higher than the documented rates. Having personally worked with many children with the illness – all of whom remained undocumented, despite attentive care from a physician, it is easy to agree with that suggestion.
Pertussis outbreaks are cyclical – usually occurring every 4-5 years and lasting around 18 months.

In conclusion – We strongly feel that it is important for ALL parents to become educated about pertussis and familiar with the sounds and symptoms of the illness, regardless of vaccine status. Obtaining the vaccine does not guarantee protection from the disease, and the protection it does provide will wane within a few years. Yes, most individuals experience little more than some inconvenience with the illness, but young children cannot tolerate it as well, and infants experience life threatening episodes. Knowing how to recognize and react to the disease protects not only your own family, but those around you – particularly the youngest infants that are most vulnerable. Our wellness courses provide detailed information on each vaccine related disease, including potential treatment options and how to work with physicians to ensure proper reporting and testing. For non-students, we recommend thoroughly researching the disease from direct sources (not various media outlets – direct sources) for accurate information on the risks and protection measures. Many holistic professionals are also prepared to assist in the personal decision making process for individual families.

UPDATE: Many of you have asked about natural ways to prevent pertussis and treat an infection. We will be posting some follow up information within the next few weeks to answer those very questions. Remember, pertussis outbreaks occur roughly every 4-5 years. The last big one was 2005, so this was not a surprise. What’s so newsworthy is the size of this outbreak as it is rapidly growing and has the potential to become the biggest since 1958. If more information becomes available about this outbreak – or why it is so large, we’ll also let you know about that and how you can protect your families and loved ones.