Do our kids need whooping cough vaccinations?

  • Posted by Dr. Jay Gordon

“Do our kids need whooping cough vaccinations?”

I’m receiving email, texts and phone calls asking this question more than ever before. I care for many families who have chosen to delay or defer vaccination and I have always strongly supported parents’ rights to participate fully in this decision. The official announcement of a pertussis (“whooping cough”) epidemic is frightening but the numbers of reported cases is higher than it has been in many years. It’s also unfair to imply that pertussis lurks around every corner or threatens the life of every school child. It’s a long very unpleasant disease that rarely leads to either hospitalization or complications. Whooping cough–like all illnesses–is much scarier and can be life-threatening to babies in the first two months of life.
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We have to get very skeptical when they sell this hard. But the skepticism shouldn’t scare parents of previously unvaccinated children from revisiting the decision.

I’m well aware that my over-reaction to the mandate to give six vaccines to a two-month-old is, “No vaccines!” That’s not the right answer.

And this is not really scientifically sound advice to families who travel a lot and might enjoy vacations less because of concern for vaccine-preventable diseases. It’s also not the best advice for many, many other families who want to discuss and continue to discuss the risks and benefits of immunization and the risks of contracting the diseases they prevent.

I have had 10-20 reports of whooping cough from at least a half dozen schools. Most of these kids got better faster than pertussis allows so they really didn’t have pertussis: lots of illnesses mimic whooping cough.

Nonetheless, it appears that this year really is one of those “peak” years in the 3-5 year whooping cough cycle. There actually is more pertussis in my state of California and elsewhere.

Notice that all news stories and even official Health Department press releases use the word “reported” not “confirmed” or “laboratory confirmed.” The reasons are that these tests cost a lot, take a long time to complete and give lots of false negatives and false positives. No one really knows how many cases of pertussis go unreported and how many reports are really not pertussis.

The CDC and others have published papers explaining that while vaccination rates are at all time highs and non-vaccination contributes to increased cases, a larger problem is the vaccine itself: the acellular pertussis vaccine confers lesser and shorter protection than the old “whole cell” shot. To diminish pertussis outbreaks we need a new vaccine. In the meantime, the vaccine we do have works for 3-4 years and unvaccinated people who now get the shot will be protected.

In recent years,I have grown increasingly comfortable giving vaccines to older children. There are side effects but no overt big side effects.

DTaP for kids 3-5 yrs and Tdap for kids older than that (“off label” under 9-10 years, but safe and effective) are simple reassurances against contracting pertussis. Giving the DTaP much younger might actually be the best answer for some families.

Hep A for travel to Africa, Asia, South America is reasonable and safe. Even one of my least favorite vaccines, MMR, is certainly safer, maybe completely safe, for kids over age three.

The short answer is no, they don’t have to get these shots but the illness so nasty and the media barrage will be relentless. There will be no break in the frightening tone of news stories and official reports.

I also agree that public health concerns are an important part of this discussion and are important as each family makes choices.

No one should scare you out of getting the shot if you want it. I am close to 100% comfortable giving it to older children and adults. If any family doesn’t want it, there is definitely a greater chance of getting whooping cough. The last estimate (guess) I saw is 1:1000 unvaccinated kids per year will get pertussis. That seems to be what I’ve seen in my years caring for children without pertussis vaccination.

Again, it is just as wrong to frighten you out of getting the vaccine as it is to frighten you into getting it.

Jay

Jay N. Gordon, MD, FAAP

June 16, 2014