HPA: Whooping Cough Cases Remain High

Credit CDC

# 5798

 

Updating a story from late in November (see UK: Three Whooping Cough Deaths In October), while the number of new UK Pertussis cases reported in November dropped over the previous month, they still remain well above average.

 

The HPA released the following update this morning.

 

Whooping cough cases remain high

21 December 2012

Figures published by the Health Protection Agency (HPA) today show that cases of whooping cough have continued at high levels during November with 1,080 confirmed cases reported for England and Wales, bringing the total number of cases so far this year to 8,819*. No deaths were reported in November.

 

The total of 1,080 cases reported during November represents a decrease from October when 1,631 cases were reported for England and Wales, which is the first time we’ve seen a decrease in monthly numbers since the current outbreak began in the middle of 2011. However, a decrease in cases is usually seen at this time of year so this does not necessarily represent the end of this severe outbreak.

 

At the end of September, the Department of Health announced that pregnant women would be offered whooping cough vaccination to protect their newborn babies, who do not usually start their vaccinations against whooping cough until they are two months of age. The aim of the vaccination programme is to help to boost the short term immunity passed on by women to their babies while they are still in the womb.

 

It is too soon for this vaccination campaign to have had an impact on the case numbers we are seeing, however, the Department of Health recently reported an uptake of around 40 per cent in pregnant women.

 

Dr Gayatri Amirthalingam, consultant epidemiologist for immunisation at the HPA, said: “The November figures show a welcome decrease of whooping cough cases since October. However, it is very important to note that we usually see a reduction in cases of whooping cough at this time of year so this decrease is in line with normal seasonal patterns.

 

“The recent announcement that at least 40 per cent of pregnant women received the whooping cough vaccine in the first month of the programme is very encouraging. We would like to remind pregnant women how serious this infection can be in young babies and how it can in some cases cause death. Vaccination between 28 and 38 weeks of pregnancy should offer babies the best protection against whooping cough before they receive their own vaccines.

 

“As well as this, parents should ensure their children are vaccinated against whooping cough on time, even babies of women who’ve had the vaccine in pregnancy – this is to continue their baby’s protection through childhood."

 

Whooping cough, also known as pertussis, affects all ages. Young infants are at highest risk of severe complications and death from whooping cough as babies do not complete vaccination until they are around four months old. In older children and adults whooping cough can be an unpleasant illness but it does not usually lead to serious complications. Whooping cough is a highly infectious bacterial disease which spreads when a person with the infection coughs and sheds the bacteria which is then inhaled by another person.

 

Dr Amirthalingam continues, “Parents should also be alert to the signs and symptoms of whooping cough – which include severe coughing fits accompanied by the characteristic “whoop” sound in young children but as a prolonged cough in older children or adults.”

(Continue . . . )

 

 

 

The reasons behind the spike in Pertussis cases (not only in the UK, but in the U.S., Australia, and elsewhere) are complex, and not completely understood, but some factors may include:

 

• lower vaccination uptakes
• the move away from whole cell pertussis vaccines to safer – but less broadly protective  - acellular vaccines in the 1990s
• evolutionary changes in the Bordetella pertussis bacteria.

 

Recent evidence published in the NEJM suggests that protection from the newer acellular pertussis vaccine – introduced in the early 1990s – may wane sooner than previously suspected. 

 

Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children

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.

N Engl J Med 2012; 367:1012-1019 September 13, 2012DOI: 10.1056/NEJMoa1200850

 

 

While not 100% perfect, the Pertussis vaccine remains the best way to prevent Whooping Cough.

 

As noted above, the rise in whooping cough isn’t just a problem in the UK.  The graphic below shows that – except for California – every state in the union has reported an increase in Pertussis cases this year over 2011 (through week 46). 

 

For more on the prevention of Whooping Cough, and the role of the Tdap vaccine, visit:

 

http://www.cdc.gov/pertussis/

 

»» Read More

UK: Three Whooping Cough Deaths In October

 

Credit CDC

 

# 6749

 

Whooping cough has been in the news (and in this blog) a lot this week (see Safety Of Tdap Vaccine In Older Patients and Waning Pertussis Vaccine Effectiveness Over Time), and with an announcement overnight from the HPA, today I go for the hat trick.

 

Last month (see The UK’s Whooping Cough Outbreak) we looked at the rising pertussis numbers in the UK, and the announcement that that pregnant women would be offered the Pertussis vaccine in order to protect their newborns, who cannot be vaccinated until they are 2 – 4 months of age.

 

The latest announcement from the HPA indicates that during the month of October more than 1,600 additional cases of Whooping cough were reported in England and Wales, resulting in 3 infant deaths.  This brings the death toll in 2012 to 13.

 

As you can see by the chart below, Pertussis in 2012 is running roughly 10 times the rate seen in recent years.

 

 

The reasons behind this latest spike in Pertussis cases are complex, and not completely understood, but some factors may include:

• lower vaccination uptakes
• the move away from whole cell pertussis vaccines to safer – but less broadly protective  - acellular vaccines in the 1990s
• evolutionary changes in the Bordetella pertussis bacteria.

 

Here are some excerpts from the HPA’s press release:

 

Whooping cough cases continue to increase

30 November 2012

Figures published by the Health Protection Agency (HPA) today reveal 1,614 cases of whooping cough were reported in England and Wales in October 2012, bringing the total number of cases so far this year to 7,728*.

 

The total number of cases so far in 2012 (up to end of October) is nearly ten times higher than for the same period in 2008, the last ‘peak’ year before this current outbreak, when 797 cases were reported. There have been three deaths in infants with laboratory confirmed whooping cough reported in October bringing the total number of deaths in this age group so far this year to 13.

 

At the end of September, the Department of Health announced that pregnant women would be offered whooping cough vaccination to protect their newborn babies, who do not usually start their vaccinations against whooping cough until they are two months of age. The aim of the vaccination programme is to help to boost the short term immunity passed on by women to their babies while they are still in the womb.

 

Dr Gayatri Amirthalingam, consultant epidemiologist for immunisation at the HPA, said: “The October figures show a continuing rise in the overall number of whooping cough cases. While there has been a decline in the number of infant cases it’s important to emphasise that it’s too early to see any impact from the pregnancy vaccination programme. Working with the Department of Health we are continuing to carefully monitor whooping cough activity to evaluate the success of the programme.

 

“We strongly recommend all pregnant women take up the offer of vaccination. Parents should also ensure their children are vaccinated against whooping cough on time, even babies of women who’ve had the vaccine in pregnancy – this is to continue their baby’s protection through childhood. Parents should also be alert to the signs and symptoms of whooping cough – which include severe coughing fits accompanied by the characteristic “whoop” sound in young children but as a prolonged cough in older children or adults. It is also advisable to keep babies away from older siblings or adults who have the infection.”

 

Whooping cough, also known as pertussis, affects all ages. Young infants are at highest risk of severe complications and death from whooping cough as babies do not complete vaccination until they are around four months old. In older children and adults whooping cough can be an unpleasant illness but it does not usually lead to serious complications. Whooping cough is a highly infectious bacterial disease which spreads when a person with the infection coughs and sheds the bacteria which is then inhaled by another person.

(Continue . . . )

 

 

For more information, the CDC maintains an extensive Whooping Cough website, including audio files designed to help you identify the often distinctive `whooping’ sound made by those infected.

 

Pertussis (Whooping Cough)

Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis.

Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many coughs, someone with pertussis often needs to take deep breathes which result in a "whooping" sound. Pertussis most commonly affects infants and young children and can be fatal, especially in babies less than 1 year of age.

(Continue . . . )

»» Read More

Study Supports Safety Of Tdap Vaccine In Older Patients

Credit CDC Pink Book

 

 

# 6746

 

With the recent rise in whooping cough (pertussis) cases around the country, and indications protection from the acellular pertussis vaccine declines over time(see JAMA: Waning Pertussis Vaccine Effectiveness Over Time) there is increased interest in booster shots for adults.

 

The Tdap vaccine (tetanus-diphtheria-acellular pertussis) booster vaccine was introduced in 2005, and  was originally licensed for those under the age of 65. New recommendations from ACIP (updated Jun 2012) now reads:

 

Any adult 19 years of age and older who has not received a dose of Tdap should get one as soon as feasible – to protect themselves and infants. This Tdap booster dose can replace one of the 10-year Td booster doses. Tdap can be administered regardless of interval since the previous Td dose. Shorter intervals between Tdap and last Td may increase the risk of mild local reactogenicity but may be appropriate if your patient is at high risk for contracting pertussis, such as during an outbreak, or has close contact with infants.

 

 

This change was inspired partly by the surge in pertussis cases in 2010, and by favorable results from unpublished data from trials on the Tdap vaccine in adults over 65 provided to ACIP by Sanofi Pasteur and GlaxoSmithKline.

 

A major study published online today in Clinical Infectious Diseases, provides some reassuring data based on nearly 120,000 seniors who received the Tdap vaccine, who were compared to a like number that received the tetanus and diphtheria (Td) vaccine.

Their findings: While there was a small increased risk of injection site reaction following Tdap vaccination, it occurred with no more frequency than with the traditional tetanus and diphtheria (Td) vaccine.

First a link to the study, then some excerpts from a press release summarizing the findings.

 

Safety of a Tetanus-Diphtheria-Acellular Pertussis Vaccine When Used Off-Label in an Elderly Population

Hung Fu Tseng, Lina S. Sy, Lei Qian, S. Michael Marcy, Lisa A. Jackson, Jason Glanz, Jim Nordin, Roger Baxter, Allison Naleway, James Donahue, Eric Weintraub, and Steven J. Jacobsen

 

 

 

Infectious Diseases Society of America

Findings support safety of whooping cough vaccine for older adults

[EMBARGOED FOR NOV. 29, 2012] A new study of the safety of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine supports the recommendation that those 65 and older get the vaccine to protect themselves and others, particularly young babies, from pertussis. Published online in Clinical Infectious Diseases, the findings come as reported U.S. cases of the bacterial infection, also known as whopping cough, are at the highest level since the 1950s.

 

In their study, Hung Fu Tseng, PhD, MPH, and his team at Kaiser Permanente Southern California found that adverse events following Tdap vaccination in seniors were mostly minor. "Although there is a small increased risk of injection site reaction following Tdap vaccination in the elderly, it is no more common than that following the traditional tetanus and diphtheria (Td) vaccine," Dr. Tseng said.

 

The researchers' study included 119,573 seniors who received the Tdap vaccine and the same number of people who received the traditional Td vaccine. Safety data were collected from seven health maintenance organizations across the U.S. The risk for adverse events following vaccination was comparable among both groups.

 

The authors hope the findings will allay any fears among older adults about the safety of the Tdap vaccine and prompt more doctors to urge across-the-board immunization, which is crucial in the wake of recent pertussis outbreaks, such as those in Minnesota, Washington state, Wisconsin, and elsewhere. Current recommendations call for infants older than 2 months, children, teens, adults (including pregnant women, parents, and health care workers), and those over 65 to be vaccinated.

(Continue . . . )

»» Read More

JAMA: Waning Pertussis Vaccine Effectiveness Over Time

Credit CDC Pink Book

 

 

 

# 6744

 

Pertussis, or `whooping cough’ was once a major childhood disease in the United States, with more than a million cases reported between 1940 and 1945, resulting in thousands of deaths. 

 

All that began to change with the introduction of a whole cell Pertussis vaccine in the 1940s.  By 1960, the number of Pertussis cases in the United States had dropped to about 15,000 cases a year – a 95% reduction over 20 years.

 

Rates dropped another 2/3rds over the next 10 years (see chart above).

 

The vaccine, while highly effective, was blamed for a variety of adverse reactions, prompting a move away from whole cell pertussis vaccines to safer – but less broadly protective  - acellular vaccines in the 1990s

 

The following chart illustrates the rise in pertussis cases, which began in earnest in the early 1990s.  The most recent years (2010-2011) are not shown, but they were among the most active in decades.

 

 

While still far below the rates seen in the 1940s, the recent rise in Pertussis cases has raised a good deal of concern these past couple of years.  A few blogs on it include:

 

The UK’s Whooping Cough Outbreak

Referral: McKenna On Pertussis Vaccines

California Reports 9th Pertussis Fatality of 2010

 

The reasons behind these increases are complex, and not completely understood, but some factors may include:

 

• lower vaccination uptakes
• the move away from whole cell pertussis vaccines to safer acellular vaccines in the 1990s
• evolutionary changes in the Bordetella pertussis bacteria.

 

Although infants are still at greatest risk from this illness, children aged 7 to 10 years old have experienced an unexpected rise in infections over the past decade.

 

A recent study published in the NEJM suggested that protection from the newer acellular pertussis vaccine – introduced in the early 1990s – may wane sooner than previously suspected. 

 

Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children

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.

N Engl J Med 2012; 367:1012-1019 September 13, 2012DOI: 10.1056/NEJMoa1200850

 

Today we can add another study, this time appearing in JAMA, that finds that the protective effect of the Pertussis vaccine begins to wane after the fifth dose (normally given at age 5) is received, leaving 7 to 10 year olds at greater risk of infection.

 

 

Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010

Lara K. Misegades, PhD, MS; Kathleen Winter, MPH; Kathleen Harriman, PhD, MPH, RN; John Talarico, DO, MPH; Nancy E. Messonnier, MD; Thomas A. Clark, MD, MPH; Stacey W. Martin, MSc

 

JAMA. 2012;308(20):2126-2132. doi:10.1001/jama.2012.14939

ABSTRACT (Excerpt)

Conclusion  Among children in 15 California counties, children with pertussis, compared with controls, had lower odds of having received the 5-dose DTaP series; as time since last DTaP dose increased, the odds increased, which is consistent with a progressive decrease in estimated vaccine effectiveness each year after the final dose of pertussis vaccine.

 

Pertussis remains a poorly controlled vaccine-preventable disease in the United States, despite a well-established childhood vaccination program and high coverage. Although infants have substantially higher rates of pertussis compared with other age groups, data from the National Notifiable Diseases Surveillance System reflect a recent increase in the number of reported pertussis cases among children aged 7 to 10 years. In 2010, this age group had the second highest incidence of pertussis in the United States.

 

The changing epidemiology raises important questions about possible waning protection from the childhood acellular pertussis vaccine series.

(Continue . . . )

 

 

This is a lengthy report, heavy on statistics.  For a less imposing summary, we have a nice write up today in Family Practice News:

 

Pertussis Vaccine Loses Efficacy Each Year After Fifth Dose

 

By: MARY ANN MOON, Family Practice News Digital Network

The odds of a child developing pertussis increase as the interval since he or she received the fifth and final dose of the DTaP vaccine increases, according to a report published in the November 28, 2012 issue of JAMA.

 

This pattern indicates a progressive waning of vaccine effectiveness every year after completion of the vaccine series, which would explain the recently noted surge in pertussis cases among 7- to 10-year-olds in at least 34 states, said Lara K. Misegades, Ph.D., of the Meningitis and Vaccine Preventable Disease Branch of the Centers for Disease Control and Prevention and her associates.

(Continue . . . )

 

As more confirmatory data comes in and is analyzed, the question then becomes what to do about this decline in protection for those aged 7 to 10 years of age.  The authors, in their conclusion, grant that their are no easy answers.

 

The increasing incidence of pertussis, changing epidemiology, and demonstrated decline in the estimated DTaP VE over time have raised concerns about the current US pertussis vaccine program and may prompt consideration of alternative schedules.

 

Options include delaying administration of the fifth DTaP dose or administering the Tdap booster at earlier than 11 years of age. However, a recommendation to delay the fifth DTaP dose until 6 years of age or later may unintentionally increase the burden of disease between the fourth and fifth doses of the childhood series, and implementation would likely be programmatically challenging because many states' school entry immunization requirements for pertussis are built around the current DTaP schedule.

 

Alternatively, shifting the Tdap booster to 10 years of age or earlier may have the unwanted effect of reducing coverage, as there is no established routine health care visit for children before the adolescent vaccine platform visit at 11 to 12 years of age.³²

 

Given the options for adjustments to the pertussis vaccine schedule, these issues will require careful and ongoing review of the epidemiology and vaccine program nationwide. Ultimately, improved control of pertussis may require a vaccine that provides longer duration of protection or differently affects transmission in the community.

»» Read More

The UK’s Whooping Cough Outbreak

Confirmed Pertussis England & Wales by year & Quarter - 2012 numbers through 2nd Quarter

 

# 6661

 

Pertussis, or `Whooping Cough’ is a highly contagious bacterial infection that can cause serious illness and even death.  Although it is thought of as a `childhood’ disease, anyone of any age can catch it.

 

It is caused by either Bordetella pertussis or Bordetella parapertussis bacteria, which are easily spread through the air by the characteristic violent coughing spasms it induces. Infection can last for 6 weeks or longer, which is why it is sometimes called the `100 days' cough’.

 

Whooping cough in England and Wales, just as we’ve seen recently in the United States (see The Never Ending Battle), is on the rise again after two very successful decades of control.

 

The chart above (from Accelerating Control of Pertussis in England and Wales – EID Journal Vol. 18, No. 1, January 2012) illustrates just how well their vaccination program worked in controlling this disease since its introduction in the mid-1940s.

 

From seeing 170,000+ cases a year before the vaccine was introduced, down to triple digits in the early 1970s, the Pertussis vaccination in England & Wales has been a huge success story.

 

While spikes in cases did occur in the 1980s, increased uptake of the vaccine brought those numbers down again by 1990.

 

The reasons behind this latest spike in Pertussis cases are complex, and not completely understood, but some factors may include:

 

• lower vaccination uptakes
• the move away from whole cell pertussis vaccines to safer – but less broadly protective  - acellular vaccines in the 1990s
• evolutionary changes in the Bordetella pertussis bacteria.

 

Recent evidence published in the NEJM suggests that protection from the newer acellular pertussis vaccine – introduced in the early 1990s – may wane sooner than previously suspected. 

 

Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children

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.

N Engl J Med 2012; 367:1012-1019 September 13, 2012DOI: 10.1056/NEJMoa1200850

 

 

All of which brings us to an HPA press release this morning, indicating that more than 6,000 whooping cough cases have been reported through the end of September, and urging parents to follow the recommended Pertussis vaccination schedule for their kids.

.

 

Whooping cough outbreak continues

25 October 2012

According to figures published by the Health Protection Agency (HPA) today, 1,322 cases of whooping cough (pertussis) were reported in England and Wales in September 2012, bringing the total number of cases so far this year to 6,121*.

 

The total number of cases so far in 2012 (up to end of September) is more than five times higher than the annual total number of cases reported in 2011 (1,118) and almost seven times higher than the total in 2008 (902) – the last ‘peak’ year before this current outbreak. In September there was one pertussis-related death in an infants under three months of age, bringing the total number of deaths in this age group so far this year to ten.

 

<SNIP>

 

“The introduction of a vaccine for pregnant women will not have an immediate impact on serious infection in infants so vigilance remains important. Working with the Department of Health we will continue to regularly monitor figures to evaluate the success of the programme.

 

“All parents should ensure their children are vaccinated against whooping cough on time, even babies of women who’ve had the vaccine in pregnancy – this is to continue their baby’s protection through childhood. Parents should also be alert to the signs and symptoms of whooping cough – which include severe coughing fits accompanied by the characteristic “whoop” sound in young children but as a prolonged cough in older children or adults. It is also advisable to keep babies away from older siblings or adults who have the infection.”

 

(Continue . . . )

 

 

This rise in Pertussis isn’t just a problem in the UK.

 

The Untied States saw a major upsurge in 2010, with more than 27,000 Whooping cough cases reported. Earlier this year the State of Washington declared a Pertussis epidemic (see MMWR Pertussis Epidemic — Washington, 2012).

 

And Australia has a record 38,500 cases (out of a population of just over 22 million) reported in 2011.

 

While admittedly not 100% perfect, the Pertussis vaccine remains the best way to prevent Whooping Cough.

 

For more on how to protect yourself, your family, and your community, the  CDC offers the following advice on Pertussis Vaccination.

 

Pertussis Vaccination

The best way to prevent pertussis is to get vaccinated. There are vaccines for infants, children, preteens, teens and adults. The childhood vaccine is called DTaP, and the pertussis booster vaccine for adolescents and adults is called Tdap. Talk to your healthcare provider about getting vaccinated against pertussis and read more about pertussis prevention.

For Those Getting Vaccinated

Pertussis Vaccine Basics
Offers comprehensive offers information about pertussis vaccines and other educational tools.

Td or Tdap Vaccine "What You Need To Know" (66 KB, 2 pages)
This one-page CDC vaccine information statement explains who should get Td or Tdap vaccine and when.

DTaP Vaccine "What You Need To Know" (58 KB, 2 pages)
This one-page CDC vaccine information statement explains who should get DTaP vaccine and when.

Vaccine Safety

Who Should Not Be Vaccinated with DTaP or Td-Tdap?

»» Read More

Referral: McKenna On Pertussis Vaccines

 

# 6465

 

 

Maryn McKenna has a terrific blog this morning about an extraordinarily difficult subject – the recent rise in Pertussis cases even among those who have previously been vaccinated.

 

I’ll just step aside and invite you to read:

 

 

Is Childhood Pertussis Vaccine Less Effective Than We Thought?

• By Maryn McKenna
• August 1, 2012 | 

 

»» Read More

The Never Ending Battle

 

Bordetella pertussis bacteria – Credit CDC

 

# 6239

 

Although humans may like to believe that we represent the pinnacle of evolution - when you look at an organism’s ability to change, adapt, evolve . . . and to survive as a species – viruses and bacteria have us beat badly.

 

Not only have they been around far longer than humans, they are likely to be here long after we are gone.

 

With replication rates that provide for new generations every few hours – instead of every couple of decades – they possess an evolutionary nimbleness that allows them to adapt quickly to a changing environment.

 

Antibiotics, antivirals, and vaccines can temporarily hold these organisms at bay – but in their 70 years or use – only two diseases have been officially eradicated (smallpox and Rinderpest) from the globe.

 

None of this is to denigrate these miracle drugs, as they have saved countless lives and reduced untold misery, over the years.

 

But bacteria and viruses are moving targets, and our vaccines and antibiotics must constantly change to keep up with them. 

 

Illustrative of the effect vaccines can have on disease rates is the following chart showing the number of Pertussis cases (whooping cough) in California over the past 60 years.

 

 

The dramatic drop in Pertussis - which began in the early 1950s – closely follows the introduction of the first whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids (DTP) was introduced in the mid-1940s.

 

Nationwide, in the 1940s, about 160,000 cases of Pertussis were recorded, and the illness claimed about 5,000 lives.

 

By 1976 the number of reported cases in the country reached a record-low of 1,010 cases, a decrease of 99%.  But over the past decade the number of cases has steadily risen, and in 2010 21,000 cases were reported.

 

The reasons for this recent rise are believed to include lower vaccination uptakes, the move away from whole cell pertussis vaccines to safer – but less broadly protective  - acellular vaccines in the late 1990s, and evolutionary changes in the Bordetella pertussis bacteria.

Which bring us to a story out of Australia, where a new strain of Pertussis (Whooping Cough) is gaining ground – one that is not controlled by the current vaccine.

 

First the study which appears in the Journal of Infectious Diseases, then I’ll be back with a press release from the University of New South Wales, with more details.

 

 

Newly Emerging Clones of Bordetella pertussis Carrying prn2 and ptxP3 Alleles Implicated in Australian Pertussis Epidemic in 2008–2010

Sophie Octavia, Vitali Sintchenko, Gwendolyn L. Gilbert, Andrew Lawrence, Anthony D. Keil, Geoff Hogg and Ruiting Lan

Abstract

Australia is experiencing a prolonged epidemic of pertussis that began in 2008. A total of 194 Bordetella pertussis isolates collected from 2008 through 2010 were typed by single-nucleotide polymorphism (SNP) analysis, by multilocus variable number tandem repeats analysis, and by fim3, prn, and ptxP sequence analyses. Strains with 2 closely related SNP profiles carrying prn2 and ptxP3 from the recently emerged SNP cluster I predominated. The data suggest increasing selection among the B. pertussis population in Australia in favor of strains carrying prn2 and ptxP3 under the pressure of acellular vaccine–induced immunity.

 

 

This from the University of New South Wales.

 

Sharp rise in cases of new strain of whooping cough

21 March 2012

Australia’s prolonged whooping cough epidemic has entered a disturbing new phase, with a study showing a new strain or genotype capable of evading the vaccine may be responsible for the sharp rise in the number of cases.

 

A team of Australian scientists, led by the University of New South Wales (UNSW),  believe this emerging new genotype (called prn2-ptxP3) of the Bordetella pertussis bacterium may be evading the protective effects of the current acellular vaccine (ACV), and increasing the incidence of the potentially fatal respiratory illness, according to the study published in The Journal of Infectious Diseases.

 

The new genotype also has been detected in other countries, suggesting it has the potential to spark epidemics elsewhere and should be closely monitored, the researchers warn.

 

“The prolonged whooping cough epidemic in Australia that began during 2008 has been predominantly caused by the new genotype of B. pertussis,” said one of the study authors, Associate Professor Ruiting Lan, of the UNSW School of Biotechnology and Biomolecular Sciences.

 

“The genotype was responsible for 31 percent of cases in the 10 years before the epidemic, and that’s now jumped to 84 percent – a nearly three-fold increase, indicating it has gained a selective advantage under the current vaccination regime.

(Continue . . . )

 

The success of the Pertussis vaccine over the past 5 decades is undeniable, and hundreds of thousands of young lives have been saved because of it.

 

But as with any vaccine, antibiotic, or antiviral – victory over any pathogen is generally fleeting – and new techniques must be developed if we are to wage this never ending battle against the evolutionary process.

»» Read More

Pssst! Immunity . . . Pass it On

 

 

 

# 5648

 

 

Two related stories today involving expectant mothers and vaccines that have been in the news over the past 48 hours.

 

Both suggest that one of the best ways to protect a newborn baby against influenza and pertussis is to vaccinate the mother before she gives birth.

 

In both cases, newborn infants are too young to receive vaccines during the first months out of the womb, but may acquire limited immunity from antibodies passed on from the mother.

 

First from the Advisory Committee On Immunization Practices (ACIP) meeting this week, a recommendation that pregnant women and other adults who will be in close contacts with a soon-to-be born infant receive the Pertussis vaccine.

 

CIDRAP has the details in last night’s news scan. 

 

 

ACIP recommends pertussis vaccine for pregnant women

To protect infants in a time of increasing pertussis cases, pregnant women as well as teens and other adults in close contact with newborns should receive pertussis (whooping cough) vaccine, an advisory group to the US Centers for Disease Control and Prevention (CDC) said yesterday. The panel, the Advisory Committee on Immunization Practices (ACIP), also recommended meningococcal vaccine for high-risk infants at 9 months, according to MSNBC. The CDC still needs to decide on the recommendations but often follows ACIP guidance.

(Continue . . . )

 

 

A second report, this time from Wake Forest Baptist Medical Center, revolves around a study that appears this month in American Journal of Obstetrics & Gynecology.

 

Impact of maternal immunization on influenza hospitalizations in infants

American Journal of Obstetrics and Gynecology, 2011; 204 (6): S141 DOI:

Katherine A. Poehling, Peter G. Szilagyi, Mary A. Staat, Beverly M. Snively, Daniel C. Payne, Carolyn B. Bridges, Susan Y. Chu, Laney S. Light, Mila M. Prill, Lyn Finelli, Marie R. Griffin, Kathryn M. Edwards.

 

It found that by analyzing data collected by CDC and the New Vaccine Surveillance Network between 2002 and 2009 (before the H1N1 pandemic), that infants born to mothers who had received the flu vaccine during pregnancy were more than 45% less likely to be hospitalized with laboratory confirmed influenza.

 

This isn’t the first time that studies have shown the benefits to the newborn child derived from maternal vaccination.  

 

Last October, in Study: Protecting Two With One Shot I blogged on Lisa Schnirring’s CIDRAP News story regarding a study that showed that babies born to mothers who received the flu vaccination experienced fewer infections and hospitalizations during their first six months than babies whose mothers did not.

 

And two years before that, we had a study conducted in Bangladesh (see CIDRAP’s Study: Flu shots in pregnant women benefit newborns) that offered pretty much the same conclusion.

 

Pregnant women (and their unborn child) are at particularly high risk from influenza due to changes in the mother’s immune system during pregnancy.  This is something I’ve written about often, mostly recently in BMJ: Perinatal Outcomes After Maternal 2009/H1N1 Infection.

 

Which is why the CDC encourages pregnant women to get the flu vaccine.

 

Pregnant Women Need a Flu Shot!

Photo Credit – CDC

If you're pregnant, a flu shot is your best protection against serious illness from the flu. A flu shot can protect pregnant women, their unborn babies, and even their babies after birth.

 

(Continue . . .)

 

 

 

While the importance of maternal flu vaccination has been stressed in pediatric journals in the past, this most recent study is geared for the OB/GYN audience, which will hopefully induce them to recommend flu shots to their patients.

 

For more on this, here is a link to the Press Release.

 

Wake Forest Baptist Medical Center

Influenza vaccination during pregnancy protects newborns

WINSTON-SALEM, N.C. – June 23, 2011 – Infants born to mothers who received the influenza (flu) vaccine while pregnant are nearly 50 percent less likely to be hospitalized for the flu than infants born to mothers who did not receive the vaccine while pregnant, according to a new collaborative study by researchers at Wake Forest Baptist Medical Center and colleagues.

(Continue . . . )

 

 

And for more on the re-emergence of Pertussis in this country, you may wish to read:

 

California Reports 9th Pertussis Fatality of 2010

California Whooping Cough (Pertussis) Update

California: Pertussis Epidemic

»» Read More

California Reports 9th Pertussis Fatality of 2010

 

 

# 4911

 

 

The last time I updated the California Whooping Cough epidemic was in late July, and at that time 6 children had already died from this preventable disease. 

 

As of the September 14th report, 3 more babies have died. California is on track to see the worst Pertussis (Whooping Cough) outbreak in 55 years.

 

Pertussis rates going the wrong way 

 

 

As you can see, in the early 1980s Pertussis was practically eliminated – thanks to the introduction of an effective Pertussis vaccine in the 1940s. Before that was available, several thousand children died each year in the United States from Whooping cough.

 

But the incidence of Whooping cough has been creeping back up over the past 30 years (and not just in California), and large regional outbreaks occur every few years.

 

That resurgence is due in part to the reluctance of some parents to get their kids vaccinated, but is also due to a lack of adults and adolescents getting their recommended booster shots.

 

As of 9/14/2010, California reports 4,017 confirmed, probable and suspect cases of pertussis for 2010, making for a state rate of 10.3 cases/100,000.

 

This is the most cases since 1955 when 4,949 cases were reported,and the highest incidence since 1962, when a rate of 10.9 cases/100,000 was reported.

 

Up until now, the worst year in the past 40 was in 2005 when 3,182 cases reported.

 

Nine infant deaths have been reported of which  8 (89%) were Hispanic.

 

Eight of the fatalities were among infants  less than 2 months of age who had not received any doses of the Pertussis vaccine.  The remainder was a 2-month old preemie that had received only one dose of the vaccine just 15 days prior to falling ill.

 

Prevention is through vaccination, but since the vaccine offered is `inactivated’ (contains no live bacteria), it requires repeated doses during childhood and a booster shot as adults.

 

 

The CDC has a simple, 2-page pamphlet on the DTaP vaccine.

 

 

 

Although the numbers are small, in recent years an increasing number of parents are filing “personal belief exemptions”, to avoid vaccinating their children.

 

California, like all states, requires that all students be vaccinated against Whooping Cough before entering school, but parents can ask for their children to be exempted from the program if vaccines run contrary to their religious or personal beliefs.

 

The following information comes from the Johns Hopkins Bloomberg School of Public Health.

 

VACCINE EXEMPTIONS

It is law in all US states that children be properly immunized before attending school.  However, in addition to medical exemptions offered in each state, 48 states allow for religious exemptions and 21^a states allow personal belief exemptions for daycare and school.

 

(Click to view)

Other states, including Idaho, Arkansas, and Texas are reporting outbreaks of Pertussis this year as well.

 

Whether due to activism or apathy, a declining rate of vaccination for preventable diseases like Whooping Cough will almost certainly lead to more cases – and more deaths – in our communities down the road.

 

For another perspective on all this, you might want to read Maryn McKenna’s post on Pertussis from last July.

 

Whooping cough: Back, with a vengeance

»» Read More

Referral: Pandemics, Pertussis and Vaccine

 

 

# 4755

 

 

DemFromCt, who is both a physician and one of the founding editors of The Flu Wiki , also finds time to write a column on the Daily Kos as well.

 

Yesterday he posted a terrific piece on Pandemics, Pertussis and Vaccine on the Flu Wiki, and also on Daily Kos. 

 

Given the reduced traffic this site sees on Sundays, I decided to wait till this morning to plug this piece to try to give it a little more exposure.

Highly Recommended.

»» Read More

California Whooping Cough (Pertussis) Update

# 4751

 

 

Once upon a time, not so very long ago, Whooping Cough infected more than a 160,000 Americans each year, and killed about 5,000 of them.

 

All that began to change in the 1940s when the first whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids (DTP) was introduced.

 

In what was a remarkable success story, by 1976 the number of reported cases reached a record-low of 1,010 cases, a decrease of 99%.

 

But since then, the number of cases has increased ten-fold, and on average 8 to 40 deaths now occur each year.  

 

That resurgence is due in part to the reluctance of some parents to get their kids vaccinated, but is also due to a lack of adults getting their recommended booster shots.  

 

Exactly a month ago I blogged on the growing California Pertussis outbreak (see California: Pertussis Epidemic).  Since then, at least 500 more cases have been detected, putting California on track for having the worst year for Pertussis in half a century.

 

Pertussis, or `Whooping Cough’ is a highly contagious bacterial infection that can cause serious illness and even death.  It is sometimes called the `hundred days cough’, because it can take months to get over.

 

Although it is thought of as a `childhood’ disease, anyone of any age can catch it.

 

Whooping cough outbreaks are cyclical, with outbreaks occurring every 3 to 5 years. California saw its last big outbreak in 2005, with more than 3,000 cases reported.

 

Prevention is through vaccination, but since the vaccine offered is `inactivated’ (contains no live bacteria), it requires repeated doses during childhood and a booster shot as adults. 

 

The CDC has a simple, 2-page pamphlet on the DTaP vaccine.

 

 

This latest appeal comes from the California Department of Public Health.

 

CDPH BROADENS RECOMMENDATIONS FOR VACCINATING AGAINST PERTUSSIS: IMMUNIZATION KEY TO CONTROLLING WHOOPING COUGH 

Date: 7/19/2010

Number: 10-048U

Contact: Al Lundeen, (916) 4407259)

SACRAMENTO

To protect Californians against the current epidemic levels of pertussis (whooping cough) health experts at the California Department of Public Health (CDPH) today broadened recommendations for immunizing against pertussis and reiterated the importance of getting vaccinated.

 

“We are facing what could be the worst year for pertussis that this state has seen in more than 50 years,” said CDPH Chief of the Center for Infectious Disease Dr. Gilberto Chávez, who also is the state’s epidemiologist. “We are urging health providers to broaden their use of the pertussis vaccine and we are urging Californians to take the simple step of getting vaccinated to prevent pertussis.”

 

• In addition to the typical series of childhood pertussis immunizations, CDPH now recommends an adolescent-adult pertussis booster vaccine (Tdap) for:
• anyone 7 years and older who is not fully immunized, including those who are more than 64 years old,
• women of childbearing age, before, during, or immediately after pregnancy, and
• other people who have contact with pregnant women or infants.

“Considering that immunity from pertussis vaccine or disease wears off and that most adults are susceptible to pertussis, now is the time for Californians to get immunized to protect themselves and their families,” said Chávez. “In particular, all family members and caregivers of infants should get the booster vaccine.”

 

<SNIP>

 

Pertussis has reached an epidemic level in California. For the first six months of this year, 1,496 cases of pertussis were reported, a five-fold increase from the same period last year when 258 cases were reported. In addition, approximately 700 possible cases of pertussis are under investigation.

 

Since this alert was released, a 6th child has died from Pertussis in California.  Five out of the six fatalities have been in infants under the age of 3 months – too young to receive the vaccine.

 

Which is why health officials urge that the general community get vaccinated, in order to protect those that cannot be immunized. 

 

And that means adults and children.

 

In recent years more parents are filing “personal belief exemptions” to avoid vaccinating their children.

 

Although California, like all states, requires that all students be vaccinated against Whooping Cough before entering school, parents can ask for their children to be exempted from the program if vaccines run contrary to their religious or personal beliefs.

 

The following information comes from the Johns Hopkins Bloomberg School of Public Health.

VACCINE EXEMPTIONS

It is law in all US states that children be properly immunized before attending school.  However, in addition to medical exemptions offered in each state, 48 states allow for religious exemptions and 21^a states allow personal belief exemptions for daycare and school.

(Click to view)

 

Other states, including Idaho, Arkansas, and Texas are reporting outbreaks of Pertussis this year as well.

 

Again from Johns Hopkins:

 

October 10, 2006

High Rates of Pertussis Found in States with Easy Immunization Exemptions

Saad B. Omer

States that easily permit parents to opt out of vaccinating their children for nonmedical reasons are at increased risk of pertussis (whooping cough), according to a new study from researchers with the Johns Hopkins Bloomberg School of Public Health, the University of Florida and the Centers for Disease Control and Prevention (CDC).

States that easily grant exemptions or offer personal belief exemptions have higher nonmedical exemption rates than states that offered only religious exemptions. The study is published in the October 11, 2006, issue of the Journal of the American Medical Association.

(Continue . . .)

 

While (mostly mild to moderate) adverse effects have sometimes been associated with the Pertussis vaccine, their incidence has dropped since the adoption of the acellular or DTaP formulation in 1991.

 

The vaccine is widely regarded as being both safe and effective.  This from the From the Immunization Action Coalition

 

What side effects have been reported with this vaccine?

About 20%-40% of children have some local reaction such as pain, redness, or swelling after the first three doses of DTaP. Such local reactions seem to be more frequent after the fourth and/or fifth doses. A temperature of 101° F or higher is reported in 3%-5% of DTaP recipients. Less common reactions (e.g., persistent crying, higher fever, febrile seizure) are rare and generally occur in fewer than 1 in 10,000 doses.

If a child has a medical reason not to receive the pertussis vaccine, they can and should still be vaccinated against diphtheria and tetanus with DT (pediatric) vaccine.

The most frequently reported side effects following vaccination with Tdap are headache, generalized body aches, and tiredness.

 

Whether due to activism or apathy, a declining rate of vaccination for preventable diseases like Whooping Cough will almost certainly lead to more cases – and more deaths – in our communities down the road.

»» Read More

California: Pertussis Epidemic

 

# 4672

 

 

Pertussis, or `Whooping Cough’ is a highly contagious bacterial infection that can cause serious illness and even death.  Although it is thought of as a `childhood’ disease, anyone of any age can catch it.

 

It is caused by either Bordetella pertussis or Bordetella parapertussis bacteria, which are easily spread through the air by the characteristic violent coughing spasms it induces.

 

Infection can last for 6 weeks or longer.  Any anyone who has had it can tell you it is miserable.

 

Prevention is by vaccination.  

 

 

The DTaP vaccine is one of the recommended childhood immunizations that protects against Diphtheria, Tetanus, and Pertussis. 

 

The CDC has a simple, 2-page pamphlet on the DTaP vaccine.

 

Adults, and children over the age of 10, should get the Tdap booster vaccine every 10 years.

 

 

Unfortunately, some people have either refused vaccines for themselves or for their children (or failed to get them) - or in the case of a lot of adults - simply don’t think about the necessity to keep up on the Tdap vaccine.

 

And so portions of the public are unprotected. 

 

Right now California is seeing a 4-fold jump in Whooping Cough cases this year, and public health officials are calling it an epidemic. 

 

Thus far, at least five children have died.

 

This from the California Department of Public Health.

 

 

WHOOPING COUGH EPIDEMIC MAY BE WORST IN 50 YEARS 

Date: 6/23/2010

Number: 10-041

Contact: Al Lundeen (916) 440-7259

SACRAMENTO

Urging Californians to get vaccinated now, Dr. Mark Horton, director of the California Department of Public Health (CDPH), warned today that the state is on pace to suffer the most illnesses and deaths due to pertussis, also known as whooping cough, in 50 years.

 

“Whooping cough is now an epidemic in California,” Horton said. “Children should be vaccinated against the disease and parents, family members and caregivers of infants need a booster shot.”

 

As of June 15, California had recorded 910 cases of pertussis, a four-fold increase from the same period last year when 219 cases were recorded. Five infants — all under three months of age — have died from the disease this year. In addition, 600 more possible cases of pertussis are being investigated by local health departments.

 

Pertussis is cyclical. Cases tend to peak every two to five years. In 2005, California recorded 3,182 cases and eight deaths.

 

Pertussis is a highly contagious disease. Unimmunized or incompletely immunized young infants are particularly vulnerable. Since 1998, more than 80 percent of the infants in California who have died from pertussis have been Hispanic.

 

The pertussis vaccine is safe for children and adults. Pertussis vaccination begins at two months of age, but young infants are not adequately protected until the initial series of three shots is complete at 6 months of age. The series of shots that most children receive wears off by the time they finish middle school. Neither vaccination nor illness from pertussis provides lifetime immunity.

 

Pregnant women may be vaccinated against pertussis before pregnancy, during pregnancy or after giving birth. Fathers may be vaccinated at any time, but preferably before the birth of their baby. CDPH encourages birthing hospitals to implement policies to vaccinate new mothers and fathers before sending newborns home. CDPH is providing vaccine free of charge to hospitals.

 

Others who may have contact with infants, including family members, healthcare workers, and childcare workers, should also be vaccinated. Individuals should contact their regular health care provider or local health department to inquire about pertussis vaccination.

 

A typical case of pertussis in children and adults starts with a cough and runny nose for one-to-two weeks, followed by weeks to months of rapid coughing fits that sometimes end with a whooping sound. Fever is rare.

»» Read More