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] GrĂ¡inne 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.



Natural Immunity VS. Artificial Immunity

I recently got into a debate with a medical professional about the comparison of immunity through vaccination versus naturally acquired immunity.

She referenced her medical textbook which stated that there was no difference between the two.

How could someone truly believe that?! You don’t have to be a medical doctor to understand the very distinct differences between the two...

To think that receiving a vaccine is no different then acquiring the disease itself is grossly misinformed and plain deceiving.

Naturally acquired immunity is magnificent, multifaceted, and something scientists are still learning about to this day. I would fathom to guess we will never truly be able to understand it in it’s entirety.  

Our body’s immune response is a multifaceted interaction between molecules, cells, and organs. This system is efficient and is able to protect an individual from outside threats as well as internal cells.

Let’s compare the cascade of events/effects when a person acquires ‘immunity’ naturally versus artificially.


Non-specific VS Specific

Let’s first appreciate that our immune system can be classified into two parts: non-specific (innate, immediate response) and specific (acquired or antigen specific). These parts are complex and are constantly communicating and interacting – something to be said of the entire immune system.

When a person attains an infection naturally, the virus/bacteria/fungus must penetrate through physical barriers (skin), chemicals factors (nasal secretions, saliva) and biological features (flora in the GI tract).

The non-specific components make up the majority of immune resistance.

“In the 1980’s Paola’s team at the Pasteur Institute in Paris showed that 98% of the immune response triggered at the early stages of infection is non-specific. [1] 
Nature Medicine, April 2000

When a person receives an injectable vaccine – these barriers are bypassed; none of the body’s cells, organs or molecules that are part of the non-specific response is activated in a way that would happen naturally.

Thinking we can “trick” our bodies into becoming immune to a disease without any consequences is simply bad science.

“The non-specific defense system responds immediately to protect the body from all foreign substances, whatever they are. The non-specific system reduces the workload of the specific defense system, by preventing entry and spread of micro-organisms throughout the entire body” [2] 
Essentials of Anatomy and Physiology 


Definition of Immunity

Immunity; 1. Protection against infectious disease by either specific or non-specific mechanisms. 2. Pertaining to the immune system or immune response [3]
Dorland’s Medical Dictionary


It is impartive to note that the definition of immunity used in every standard dictionary includes both non-specific and specific components.

Relying soling on a vaccine would not fall into terms of this definition.


Ports of Entry

A vaccine is injected into the muscle of an individual, directly into the bloodstream.

This is quite the opposite of what would happen naturally. The majority of pathogens enter through a person’s mouth or nose which are heavily lined with mucous membranes, packed with IgA.

“IgA is the key defender against viral infections”[4]
Essentials of Medicine

In the events triggering natural immunity, a remarkable amount of biological events occur which trigger the body’s ability in developing true immunity. This happens before the virus or bacterial come in contact with the host’s bloodstream.


Antibody Production

Vaccines sole intent is to elicit an antibody reaction from the individual. However, it is still uncertain if elevated antibody titers confer immunity or protection from disease.

Natural immunity involves many organs and systems. This complex system is completely evaded when relaying on vaccines to confer protection.

There is no relation whatsoever between antibody count and incidence of disease. The researchers found people who were highly resistant with extremely low antibody counts, and people who developed the disease who had high antibody counts.

Dr. Burton also discovered that children born with a-gamma globulinemia (inability to produce antibodies) develop and recover from measles and other infectious or contagious disease almost as quickly as other children.[5]
Dr. Alec Burton, published by the British Medical Council 


Life-Long Immunity

One of the fundamental features of the immune system is its ability to respond and remember an invading virus or bacteria.

A problem occurs here with the use of vaccines because T cells (memory cells) are extremely slow learners. The most recent research shows that the ability for a T cell to remember requires many encounters instead of one initial exposure.


“It is true that natural infection almost always causes better immunity than vaccines. Whereas immunity from disease often follows a single, natural infection, immunity from vaccines occurs only after several doses.” [6]Children’s Hospital of Philadelphia

“The antigens contained in many inject able vaccines will not produce an immune response sufficient enough to confer protection against infection. Of the 23 vaccines currently in routine use, 20 are delivered by injection and stimulate only systemic immunity”  [7]Avant Immunotherapeutics

“It is dangerously misleading and indeed the exact opposite of the truth to claim that a vaccine makes us “immune’ or protects us against an acute disease, if in fact it only drives the disease deeper into the interior and causes us to harbor it chronically, with the result that our responses to it become progressively weaker and show less and less tendency to heal or resolve themselves spontaneously” [8]Dr. Robert Moskowitz, Dissent in Medicine


Conclusion

Vaccines are touted as the biggest gun in our arsenal of preventative medicine; not nutrition, sanitation or daily lifestyle choices.


In response to my discussion with the medical professional that so confidently stated there is no difference between the response a vaccine elicits versus the naturally occurring immune response, I think it is evident that the stimulation by a vaccine is not even remotely close in duplicating the response received from natural exposure.

Personally, I think we would be much more effective at evading disease if we shift our focus from disease prevention and management to enhancing health and wellbeing. The importance of nutrition, exercise and positive lifestyle choices should not be down-played by modern medicine.

It is important to embrace the concept that many diseases are normal and natural, that they may actually strengthen the immune system and benefit the body.

With the rise of vaccines and antibiotics, people in developed countries have experienced fewer childhood diseases than ever before and scientists suspect that an immune system with no serious work to do is likely to become a renegade army, attacking whatever it encounters[9]
Newsweek, 1997

Several studies have shown that the incidence of asthma and allergies tend to rise in countries where childhood immunization rates are high. This has prompted researchers to suggest that certain infections may trigger immune changes that protect children from developing asthma and allergies later. Preliminary studies have shown a protective effect of measles and infections with intestinal parasites. [10]
Science News, 1997

Infection with an organism does not necessarily mean diseases, since the immune system in most cases will be able to eliminate the infection before disease occurs. Disease occurs only when the bolus of infection is high, when the virulence of the invading organism is great or when immunity is compromised. [11]



References:
[1]Degrave W. “A B-cell mitogen from a pathogenic trypanosome is a novel eukaryotic proline racemase” Nature
[2] Marieb, E. Essentials of Anatomy and Physiology, WB Saunders, 2000, Philadelphia.
[3] Ingelfinger, F.  Dorland’s Medical Dictionary  Saunders Press, 1999.
[4] Andreoli, T. Essentials of Medicine, WB Saunders, 2001, Philadelphia.
[5] Null G. Vaccines: A Second Opinion, 2000.
[6] Childrens Hospital of Philadelphia, www.vaccine.chop.edu.
[7] Choang K Avant Immunotherapeutics.
[8] Moskowitz R. Dissent in Medicine Contemporary Books, 1985 p.142.
[9] Underwood, A. “Why Ebonie cant breathe” Newsweek,  May 26, 1997
[10] Raloff, J. “Childhood Vaccinations” Science News  Jan 25, 1997
[11 Gene Mayer, Ph.D. IMMU
NOLOGY - CHAPTER ONE. INNATE (NON-SPECIFIC) IMMUNITY. Microbiologyand Immunology On-Line. University of South Carolina School of Medicine http://pathmicro.med.sc.edu/ghaffar/innate.htm
Quotes 1-10 were gathered from Keith Wassung. “Challenging the Theory of Artificial Immunity.” Dr. Wassung is a nationally known author and speaker in the field of health education and research. http://atlaschiro.com/great_stuff/challenging_the_theory_of_artificial_immunity/

Bullies, Stalkers & Trolls... OH MY!

This post may be a bit off topic today from  what I normally write about – but I’ve been motivated by recent events of the on-goings at TFB.


If you’ve spent any amount of time online on social networking sites, blogging or the-like then it is safe to assume you are familiar with, engage in or know someone that intentionally provokes or harasses others online.

Now, it is not at all surprising that the internet teams with people like this…however, it is shocking to find out so many young people are effected by it…maybe this is shocking to me because my generation really wasn’t affected by it. 

I think about how my daughters will be affected by it in just a hand full of years.

I think about how my own teenage years would have been different if I grew up being bullied (or bullying others) online.



Danni Sanders, 14 years old, was bullied on the internet, took her own life on a Tuesday afternoon. Her mother Christine and younger sister Monique, 12, discovered her in the bathroom following days of violent and aggressive behavior online.[*]


Jessica Laney, a 16-year-old Hudson girl took her own life.  Friends of the Jessica said bullying through social media played a key role. Officials say Laney hung herself. [*]
 



I’m a grown woman and I am exposed to consistent trolling and bullying from other grown adults. Now, I have the ability to remove myself from it and know well enough never to read or perpetuate those people  which I I’ve managed to do for a very long time –

…but to think I may be helpless when it comes to my daughters being harassed…

…nothing could make me more sick to stomach.



A 13-year-old girl, Megan Meier, hung herself after she fell victim to a cyber-bullying campaign orchestrated by the mother of one of her classmates[*]


Eden Wormer, 14 years old, who endured years of bullying online reportedly hugged her father and told him “I love you, Daddy, goodnight,” before hanging herself that Wednesday evening. [*]
 



This post isn’t about communicating research or providing support – and I apologize if this is somewhat coming from left field…but what are parents supposed to do with stuff like this? 


I think of the bullying I used to do in high school and how that would be been exaggerated and compounded through the use of the internet to those victims…god only knows if those other young girls would have tried to hurt themselves because of what I did! 

Luckily, I’ve out grown that, as most (not all) adults do.

When I think about it – maybe the best we can do is to understand trolling/online bullies for what it truly is: engineered to be socially and personally destructive that always carries a risk of not only emotionally/mentally hurting others but also.... physically.

These people are not sitting in the same room as those they are intentionally trying to hurt, instead that are completely removed from the negative consequences of being face-to-face.  They don’t realize how far they are pushing the one person – just how fragile a young life is.

And since well over half of young people don’t even tell their parents when they are being harassed online, we must implant and set an example in them that it is NEVER acceptable or tolerable to terrorize and harass people, either online or in “real life”.

Suicide is the third leading cause of death among young people and at least half of suicides among young people are related to bullying.[*][*]
For every suicide among young people, there are at least 100 suicide attempts.[*][*]
Over half of adolescents and teens have been bullied online, and about the same number have engaged in cyber bullying. [*][*]