Pertussis?

Friday night, right at bedtime, Sarah started coughing.  It was a little, squeaky cough that seemed completely unrelated to any mucous.  We thought perhaps it was allergy related.  She coughed 3 or 4 coughs in succession every 5-10 minutes.  After a few hours of this, she developed a low-grade fever.  She coughed so hard she threw up.  It was a very long night.  

The next day, I decided to take her to the doctor just in case she had a sinus infection.  Joel had one the week  before and I wanted to rule it out before things got worse (during a weekend, no less.)  Chris thought I was being silly over a cold.  It just seemed....different somehow, though I couldn't explain it.  He was against it, but he insisted I go for peace of mind.  

The doctor came in and gave me a gentle, sad smile when I mentioned a possible sinus infection.  She said she'd heard Gracie coughing in the waiting room and that it was distinctly a pertussis cough.  

Now, I spent a year rabidly researching vaccines before Honor was born, weighing the risk of complications from vaccines against risk of complications from diseases.  It was not a light decision, but Chris and I felt our conscience would be clearer if we erred on the side of no vaccines.  We opted to stay open minded and to continue to research and consider vaccines for when they were older.  Though I knew from research that such a diagnosis was a possibility and not dangerous, flashes of fear-mongering articles jumped to mind the moment the doctor mentioned whooping cough.  The doctor saw my flash of fear and instantly reassured me that it was "nothing serious" and that Sarah would be a new girl by morning if we started antibiotics that afternoon.  She also wrote a prescription for Honor because it is so contagious.  Indeed, Honor's allergy cough started sounding like Sarah's distinct 4-in-a-row, dry cough about 4 hours later.  

We started antibiotics that afternoon and by morning, Sarah was a brand new girl.  No real cough, no fever, no breathing trouble.  Honor isn't far behind her in recovery.  We are still doing our favorite sick stuff, including the ultimate comfort food: Nutella on Toast with Bergamot tea and cane sugar.  Sarah is loving being "sick".  I'm not minding it so much myself.  Mmmmm, I love Nutella. 

Even though she's feeling all better, she is still considered contagious for a week, so we'll be sticking close to home.  

And that concludes my family-update post.  If you are interested in the pertussis vaccine, keep reading.  Otherwise.  See you tomorrow!

If you keep reading, please know that this is just plain old me, reading and researching.  I have no medical background.  I just read.  I recommend reading for yourself and looking for your own conclusions.  Here is what I came up with, but it does not mean I am ready to debate any of it.  It just means I found it interesting and thought I'd share.

Even if you've had the vaccine, 34% of those vaccinated are not immune and could still catch it.  And, unless you've had the vaccine within the last 10 years, you are not immune.  It does not give permanent immunity.  The doctor told us that most children actually catch pertussis from adults who think they just have a cold.  Adult tetanus vaccines are being paired up with pertussis though, so the future will yield more immunized adults, assuming they get the tetanus vaccine (which I support.)  These are actually very generous numbers.  Some studies show as few as 33% of vaccinated individuals actually showing immunity, which means 67% of vaccinated individuals do not show immunity. Some studies showed the vaccine lasting only 3-5 years rather than 10.  

One of the least fear-infused articles I've read still says this:

How common is pertussis?

Before the availability of pertussis vaccine, pertussis was one of the most common childhood diseases and a major cause of death in children in the United States. Since widespread use of the vaccine began, cases have decreased by 99 percent, but about 5,000 to 7,000 cases per year are still reported. In unimmunized populations in the world, pertussis remains a major health problem in children and causes an estimated 300,000 deaths per year.

As terrible as this is, it should be noted that the time during which it was considered a major cause of death in children was before the availability of the vaccine....which was in the late 1930's.  Since antibiotics weren't commonly used until the mid 1940's, I'd say we're quite a bit ahead of the game even without the vaccine.  Also, while 5-7,000 cases are still reported, it is estimated that only 5-10% of pertussis cases are ever reported. Yes, this means pertussis is far more common, but it also means 90% of the cases are not worth reporting. And by "major health problems" the most common side effect is an ear infection, which is also easily fixed with an antibiotic.  

There are many case studies available online and I haven't found any that hinted at the 300,000 deaths per year. I'm hopeful that such a number was not made up, but am left wondering what the medical conditions are like in the areas where these deaths are occurring.  This UK study looks like the majority of other studies I've read online. Out of 500 studied, "Five patients developed pneumonia, three of whom had been immunised. Three patients required hospital admission. ^{"   No deaths were reported.}

The "facts" vary wildly in some of these cases.  One says unvaccinated children are 11% more likely to catch pertussis. Another says 23%.  One says 2000% more likely! The last one used creative math though and was mostly just entertaining.  

None of this is said to to downplay the seriousness of any child being affected by this disease.  Complications do occur. Also, none of this is said to convince others NOT to vaccinate. Not by any means.  Rather, I hope just to shed light on why some families choose not to vaccinate and to relieve the fears of any who are concerned about catching pertussis.   

Consider that "among all pertussis hospitalizations during 1994-2003 in children under age 2 years, 92% occurred in infants under 6 months of age."

Then consider the fact that...

#1 these children were too young to be vaccinated.

#2 according to some studies, only 0.2% of the reported cases are hospitalized.  Keeping in mind that 10% of the cases are reported, this is not the same as saying 0.2% of all cases of pertussis are hospitalized.  Quite different altogether.

#3 These infants would not be protected from any "herd immunity" since the vaccine is only effective for 34-64% of the population (depending on who you read) and only lasts for 3-10 years (depending on who you read.)

So the real question for me, as a mom, is this:  If my child were that one in a million case that had serious complications from pertussis....how would I feel having rejected a vaccine for that disease?  Devastated, but not guilty.  As guilty, I suppose, as I would feel if my child were that one in a million case that had serious complications from the pertussis vaccine.  And according to some studies (sad how they do not match up, isn't it?) my odds are better, mathematically, in rejecting the vaccine.

For the record, I avoid the sensationalized, non-vaxing articles that use poor grammar and worse science.  I have tried to gather as much data as possible from pro-vaccine studies.
Here are some:
http://www.surv.esr.cri.nz/PDF_surveillance/NZPHSR/2004/NZPHSR2004December.pdf
http://pediatrics.aappublications.org/cgi/content/full/115/5/1422
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=8527557&ordinalpos=40&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://jama.ama-assn.org/cgi/content/full/290/22/2968

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