The Perfect Storm - How the increase in pertussis vaccine usage is causing an 'epidemic'

If you live in the United States then you and your children most likely have had at least one pertussis (DTP, DTaP, Tdap) vaccination – fair to say, that you’ve had multiple injections over your lifetime…and you are urged to continue to get them.

According to the CDC, despite the high vaccination rates, the number of reported cases of pertussis has increased steadily since the 1980s. [1]

Curious enough, we are experiencing the highest vaccination rates against pertussis ever recorded in the US.

Then what the heck is going on? Shouldn’t we be seeing a decline…or at the very least no increase.

Lucky for us, there is a scientific library accumulating as we speak with published works about the Bordetella spp. bacteria and acelluar vaccines- one which might have us considering the increase in vaccine usage is contributing to a combination of circumstances that is causing a rise in Bordetella infections.

A perfect storm.

A "perfect storm" is an expression that describes an event where a combination of circumstances will aggravate a situation drastically.

So, what could be the circumstances contributing to the increase in pertussis/parapertussis infections in the United States… (reiterating here: even with the highest rates of vaccine coverage ever experienced)?

Can you think of any? I can -

Vaccinated population as asymptomatic carriers of pertussis

To understand this factor we have understand an important aspect of illness: clinical stages of disease.

Pertussis is an acute infection of the upper respiratory tract caused by Bordetella bacteria (B. pertussis and in some cases B. parapertussis) which last approximately 6 week and has three clinical stages.

The initial stage resembles a common cold with a mild cough, followed by the second (paroxysmal) stage that is characterized by the repetitive episodes of coughing fits and the typical “whoop” cough. The final stage lasts 1-2 weeks and marks a decrease in the frequency and severity of the cough.[2]

It has been recurrently documented (and touted as a benefit to getting vaccinated) that infected vaccinated individuals will suffer a milder, nonspecific form of the disease. Specifically, infections in the vaccinated population cause nonspecific symptoms.

Vaccinated adolescents and adults become reservoirs for silent infection and transmitters. [3][4][5][6][7][8]

Pertussis vaccination increases susceptibility and enhances performance for B.parapertussis bacteria.

There are 3 species of Bordetella bacteria that are human pathogens, however only the B. Pertussis and B. Parapertussis can cause whopping cough in humans.

The pertussis (aP) vaccination not only makes a person more susceptible to B. parapertussis infection but it enhances the performance of the pathogen. [9]

Research has illustrated a 40-fold increase in B. parapertussis lung colony-forming units after vaccination of aP injections.[9]

A little side note about evolution here (because evolution is neat to learn about)- because of the O-antigen that is found only on B. parapertussis, immunity derived from B. pertussis does not protect against infection by B. parapertussis. The parapertussis bacteria are free to colonize a host's lungs without being subject to attack by previous pertussis antibodies. This particular finding suggests that B. parapertussis evolved in a host population that had already developed immunity to B. pertussis, where being able to evade B. pertussis immunity was an advantage.[10]

If I was a gambling woman, I would bet that we will be subjected to a parapertussis vaccine within the next 8 years.

Increase in antibiotic resistance with a standstill in new research & development

Antibiotic treatment plays an important role in treatment of pertussis and parapertussis in the United States. Erythromycin helps eliminate the Bordetella organism from the respiratory tract and is currently the treatment of choice for patients with confirmed and pertussis and their close contacts.[11]

The first case of erythromycin-resistant B. pertussis was identified in Yuma, Arizona in 1994. To-date, four additional cases of erythromycin-resistant B. pertussis have been reported in the United States. Most recently, screening of 1,030 isolates of B. pertussis revealed an additional five strains exhibiting a heterogeneous erythromycin resistance phenotype.[11]

 

As you might know, antibiotic-resistant bacteria make it difficult—sometimes impossible—to treat serious infections.[12]

This is because when certain antibiotics are used to kill bacteria, a few may survive because they happen to have the appropriate genes; thus they will become the predominant strain. For example, if an antibiotic kills ten million bacteria but doesn’t kill five that are resistant, at their incredible multiplication rate (bacteria divide approximately every 20 minutes) after 15 hours there will be 5 million descendants of those five, all of them resistant to the antibiotic.[12] 

Neat huh? Some bacteria even carry antibiotic resistance genes that can be passed to other species of bacteria.[12]

Not so good news? New antibiotic drug development and research is stalling. The main reason behind this is because pharmaceutical companies don’t have very many incentives for developing antibiotic drugs. Why focus on research for drugs that people will only take for a few days versus development on drugs for chronic illnesses such as arthritis and heart disease which people will take for years?[13]

Vaccine Failure

Children in the United States receive five doses of diptheria, tetanus and (aP) pertussis (DTaP) vaccine before the age of 7, yet duration and effectiveness protection is unknown.[14]

To reiterate, despite high vaccination rates, the number of reported cases of pertussis in the United States has increased steadily since the 1980s.[1]

This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the vaccine does not prevent transmission of the causative agent (B. pertussis) within the population [15]

Despite detailed analysis of several virulence-associated factors of B. pertussis, significant gaps remain in the understanding of the pathogenesis of the infection and disease. [16]

Something that is becoming more evident and important in understanding why the vaccine is much less effective then believed is that clinical efficacy trials of the (aP) pertussis vaccines did not yield any correlation between antibody levels and protection against pertussis.[17]

The mechanisms of vaccine-induced immunity remain elusive. [17]

The current vaccines contain antigenic components for 3 pertussis antigens (Filamentous hemagglutinin, Pertactin, and the pertussis toxin itself [PT]). [17]

Unfortunately, research of the pathogensis of infection confirms that the vaccine is omitting a vital toxin. The adenylate cyclase toxin (CyaA or also known as ACT).[15][16]

Despite the widespread national childhood vaccination program against B pertussis, the disease remains prevalent.[18]

And despite over 50 years of this population-wide vaccination, whooping cough incidence is on the rise.[9]

The new 2013 recommendation for pregnant moms

The CDC confirms that more than 41,000 cases of whooping cough were reported last year, the highest level in more than 50 years and more than double the 2011 total.[19]

The disease was linked to 18 deaths in 2012, with the majority of them babies younger than 3 months old.[19]

The CDC and ACIP no longer demands a superior vaccine-instead the latest recommendation is to vaccinated pregnant mothers - during EACH and EVERY pregnancy.[19]

This is contrary to what the manufacture shave proven is safe and what is approved by the FDA. However, doctors do not need FDA approval to recommend and administer the vaccine repeatedly to pregnant women.[19][20]

In fact, there is no data at all to support repeat administration of Tdap in any population, especially pregnant women.[20] 

This should be cause for concern for anyone that just read this post for one main reason (1) due to the vaccine causing only subclinical, asymptomatic signs of infection - if vaccinated mothers with newborns do contract pertussis they will only think it's a slight cold and they will be less inclined to seek medical attention.

Nevermind that the vaccine has not been studied for safety in pregnant mothers and their fetus(es).

To date, one clinical trial was completed using pregnant mothers. The results are not published or available for review. The trial consisted of 48 pregnant woman and 32 non pregnant women. Both groups received a combination vaccine. Now, don't get me wrong, I'm not a clinical researcher - but the assessment of safety seems mute if both groups are receiving a vaccine with one not even pregnant to begin with. [21]

Research on this cocoon strategy is highly inefficient - and I'm going to go out on a limb here and say that it is also reckless.[22]

References:

[1] Weiss, A., Patton, A., Millen, S., Chang, S.j., Ward, J., Bernstein, D. Acellular pertussis vaccines and complement killing of bordetella pertussis. American Society for Microbiology (Infection and Immunity). Vol 72(12): 7346-7351. Dec 2004.

[2] WHO meeting on case definition of pertussis: Geneva 10-11 January, 1991. Geneva: World Health Organization, 1991:4-5 (issue no. MIN/EPI/PERT/91.1)

[3]Jenkinson D. Duration of effectiveness of pertussis vaccine: evidence from 10-year community study. BMJ 1988;296:612-4.

[4] Christie CD, Marx ML, Marchant CD, Reising SF. The 1993 epidemic of pertussis in Cincinnati: resurgence of disease in a highly immunized population of children. N Engl J Med 1994;331:16-21.

[5] Rosenthal S, Strebel P, Cassiday P, Sanden G, Brusuelas K, Wharton M. Pertussis infection in young adults during the 1993 outbreak in Chicago. J Infect Dis 1995;171:1650-2.

[6] De Melker HE, Conyn Van Spaendonck MA, Rumke HC, van Wijngaarden JK, Mooi FR, Schellekens JF. Pertussis in the Netherlands: an outbreak despite high levels of immunization with whole-cell vaccine. Emerg Infect Dis 1997;3:175-8.

[7] Yaari E, Yafe-Zimerman Y, Scwartz SB, Slater PE, Shvartzman P, Andoren N, et al. Clinical manifestations of Bordetella pertussis infection in immunized children and young adults. Chest 1999;115:1254-8

[8] I. Srugo, D. Benilevi, R. Madeb, S. Shapiro, T. Shohat, E. Somekh, Y. Rimmar, V. Gershtein, R. Gershtein, E. Marva, and N. Lahat. Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel. Emerging Infectious Diseases. Vol 6(5): 526-529. Sept/Oct 2000 PDF: http://wwwnc.cdc.gov/eid/article/6/5/pdfs/00-0512.pdf

 [9] Gráinne H. Long, Alexia T. Karanikas, Eric T. Harvill, Andrew F. Read and Peter J. Hudson. Acellular pertussis vaccination facilitates Bordetella parapertussis infection in a rodent model of bordetellosis. Proceedings of the Royal Society (Biological Sciences). Vol 277 (1690):2017-2025. Jul 2010

[10] Wolfe D, Goebel E, Bjornstad O, Restif O, Harvil E (2007). "The O Antigen Enables Bordetella parapertussis To Avoid Bordetella pertussis-Induced Immunity". Infection and Immunity 75 (10): 4972–9. doi:10.1128/IAI.00763-07. PMC 2044517. PMID 17698566. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2044517/.

[11] J. M. Bartkus, B. A. Juni, K. Ehresmann, C. A. Miller, G. N. Sanden, P. K. Cassiday, M. Saubolle,  B. Lee, J. Long, A. R. Harrison, Jr., and J. M. Besser. Identification of a Mutation Associated with Erythromycin Resistance in Bordetella pertussis: Implications for Surveillance of Antimicrobial Resistance. J Clin Microbiol. 2003 March; 41(3): 1167–1172.

[12] Vaccines and Antibiotic-Resistant Bacteria. National Network for Immunization Information. Dec 22, 2005

[13] Lallanilla, Marc. Antibiotic-Resistant Disease Crisis May Bring 'Apocalyptic Scenario,' UK Health Officer Says. Huffington Post (originally posted on Live-Science). Jan 25, 2013

[14] Nicola P. Klein, M.D., Ph.D., Joan Bartlett, M.P.H., M.P.P., Ali Rowhani-Rahbar, M.D., M.P.H., Ph.D., Bruce Fireman, M.A., and Roger Baxter, M.D.Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children. The New England Journal of Medicine. Sept 13, 2012. 367:1012-1019.

[15] Ori Hochwald, Ellen Bamberger and Issaac Srugo. The Return of Pertussis: Who is Responsible? What Can Be Done? Israel

[16]Vaccine Research Initiative. Vol 8: 301-307. May 2006[14]Nicholas Carbonetti. Pertussis toxin and adenylate cyclase toxin: key virulence factors of Bordetella pertussis and cell biology tools. Future Microbiol. Vol 5: 455-469. Mar 2010

[17] Hewlett, Erik. Pertussis: current concepts of pathogenesis and prevention. Pediatric Infectious Disease Journal. Vol 16(4): S78-S84. Apr 1997

[18]Maxwell A. Wit1, Paul H. Katz, and David J. Witt. Unexpectedly Limited Durability of Immunity Following Acellular Pertussis Vaccination in Preadolescents in a North American Outbreak. Clinical Infectious Diseases. (Mar 2012) 54 (12: 1730-1735.

[19] Dooren, Jennifer.Panel Pushes Vaccine for Pregnant Women-Amid Whooping Cough Crisis, New Guidelines Recommend Mothers Get Vaccinated at Each Pregnancy. The Wallstreet Journal. Jan 28 2013.

[20] Boostrix package insert. GlaxoSmithKline

[21] Pertussis Vaccine in Healthy Pregnant Women. Sponsor: National Institute of Allergy and Infectious Diseases (NIAID). Clincila Trial ID # NCT00707148.

[22] Danuta M. Skowronski, Naveed Z. Janjua, Elodie P. Sonfack Tsafack, Manale Ouakki, Linda Hoang, and Gaston De Serres.The Number Needed to Vaccinate to Prevent Infant Pertussis Hospitalization and Death Through Parent Cocoon Immunization. Clinical Infectious Diseases. DEC 2011.