Pertussis is a disease of the wealthy

California’s whooping cough epidemic is centered in rich, white counties, reports the California Department of Public Health.

Affluent whites are “dumb enough to believe the anti-vaccine crap,” writes Instapundit.

Whooping cough rates are high for Latino babies under two months old,  but illness rates go down rapidly once babies are old enough for the pertussis vaccine.

Update: Middle-class English children are suffering from rickets because of overuse of sunscreen, doctors say.

About Joanne

Comments

  1. Cardinal Fang says:

    Sadly, pertussis is most deadly for those under-two-months babies, who catch it from older children whose negligent parents don’t vaccinate them. Responsible Latino parents end up having sick infants because white morons don’t vaccinate their kids.

  2. I had all my vaccines (and then some, for I travelled internationally as a child) and still got a medically documented case of the measles when I was in college. So we can’t say the vaccines protected me at all.

    I am not sure where Cardinal Fang is getting the “responsible” Latino parents line. Were these parents breastfeeding their children? That is the only “responsible” way to parent, you know, for it passes antibodies to infants during that crucial first few months. Only a negligent moron wouldn’t do the healthiest thing for her kid.

    Sound judgmental? So does that comment, with all due respect. Someone who doesn’t make the BEST choice in your opinion is not necessarily “negligent,” particularly as the choice not to vaccinate is specifically protected by law. Were it not, perhaps you would have a point.

    But really. Morons? Negligent? Dumb enough to buy crap? Those “arguments” are NOT going to sway people on the other side of the debate. They just aren’t.

  3. PS. No, I don’t think that it’s negligent not to breastfeed. I was being extreme to make a point.

  4. It’s helpful if adults get the pertussis booster with the tetanus booster. We have a pertussis wave coming through my county — it is disproportionately hitting the poorer areas. I’m not sure with whom the fault lies. There’s also a polio epidemic in Africa.

  5. Joanne – you should look at the report linked in that article.
    You’ll see that the highest infection rates are concentrated in two areas:

    1) The costal counties north of San Francisco.
    2) The central valley.

    I’m not sure what those two areas have in common.

  6. A recent study has suggested that adults are not acting as a reservoir for pertussis, so adult boosters would do little to combat the current outbreaks in the west. The outbreaks are likely due solely to the unvaccinated child population.

    Happy Elf Mom – vaccines are not 100% effective, even with boosters, due to the various characteristics of each individual’s immune system. It is very possible for someone to contract a disease they are immunized against, especially if they are exposed to a wide and diverse population (like at college). Vaccines work best to protect a whole population when nearly 100% of the population is vaccinated.

  7. Rich whites are not just dumb enough to believe the anti-vaccine hysteria; they are arrogant and selfish enough to expect everyone else to vaccinate their kids so that there is enough herd immunity to protect their kids.

  8. This is a problem linked with Waldorf Schools (and Waldorf Schools mostly attract the white and privileged).

    Joanne, you know that, so it’s mysteriously glaring that you don’t mention it. f the hazard posed by unvaccinated kids is a concern worth reporting, it’s a big hole not to mention the problem posed by Waldorf schools that attract families that aren’t inclined to vaccinate and further encourage them not to vaccinate, minimizing the herd-immunity protection.

  9. Cardinal Fang says:

    Ten California babies have died this year from pertussis, nine of them Hispanic. The death rate for babies under three months is almost 1 in 50. One in fifty!

  10. Actually, the problem is not so much vaccine refusal (which is rare despite all the scapegoating in the media & blogosphere) but rather that few Californian adolescents are getting the recommended booster shot at 11 or 12. The highest rate of pertussis aside from infants is in the 9-17 age group. CA is one of only 11 states that do not require the pertussis booster shot for middle school entrance and Medi-Cal does not pay for it. As a result, only about 43% of CA teens have received the booster.

  11. Cardinal Fang says:

    I took another look at the data. As Joanne reports, for babies the infection rates are reported to be highest among Hispanics, but at older ages, the infection rates are higher among whites.

    Here’s a possible explanation, which fits the facts as I know them, but is just conjecture: How do we get the data? Reports from doctors and hospitals. But maybe all the cases are not reported. If your infant has pertussis, it’s a very serious disease indeed. Whatever your income, whether you have health insurance or not, you’re going to take that sick baby to the doctor or the emergency room and worry about paying later. So infant pertussis cases are likely to be reported to the doctor for all races.

    But pertussis in older-aged kids, while serious, is not as serious. Maybe some older Latino kids have pertussis, but are not being treated for it because their parents can’t afford to pay.

  12. Cardinal Fang says:

    Crimson, The report says the highest rate is among babies less than 6 months, the next highest rate is 7 to 9 year olds, then 6 months to 6 years, then 10 to 18 years. And the report says the highest rates of adolescents (10-18 years) is among 10- and 11-year-olds, who wouldn’t have gotten the booster yet anyway.

    http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2010-11-09.pdf

  13. Interesting- the LA Times article I read indicated that the outbreak was mostly among adolescents: http://articles.latimes.com/2010/jun/28/local/la-me-whooping-cough-immunization-20100627

  14. Cardinal Fang says:

    Crimson, your article was from June. The report I quoted (from the California Department of Public Health) is dated November 11, 2010. The June article reported 1000 cases of pertussis. Now we’re up to 6613 cases. Maybe at first school aged kids were getting pertussis but now it’s babies. Or something.

  15. SuperSub, I know vaccines are not 100% effective. Scapegoating people who do not vaccinate, therefore, is rather silly. Presumably I was just as contagious with the measles when I had them as someone who did NOT vaccinate and had them.

    I remained in my dorm room until I was better.

    My point really was that calling people moronic, stupid and negligent really doesn’t help the issue. Intelligent people are perfectly capable of making decisions with which we disagree. Why the hate?

  16. Cardinal Fang says:

    ” I know vaccines are not 100% effective. Scapegoating people who do not vaccinate, therefore, is rather silly. ”

    We also know that vaccines are not 0% effective. We know that diseases spread faster among unvaccinated groups than among vaccinated groups. So I’m perfectly happy to scapegoat parents who don’t vaccinate their children. In fact, I’m perfectly willing to pin ten dead babies on them. So go ahead. Don’t vaccinate your children… as long as you don’t care if babies die of preventable diseases.

    Ten dead babies. Thanks, vaccine refusers.

  17. Joanne, On the one hand, I think your headline — or the conclusion it implies — is premature. The picture continues to be murky, for example:

    Readers outside of California may not know of KQED’s Quest Community Science blog Last month, they published an interesting article on “Personal Belief Exemptions” (PBEs) to vaccine mandates:

    http://www.kqed.org/quest/blog/2010/10/13/health-officials-to-consider-tightening-vaccine-exemptions/

    including a map indicating vaccine exemption rates. Kern, Tulare, Fresno, Madera, Merced & Colusa counties have averate- to below-average rates of PBEs, but are experiencing the highest pertussis rates. Trinity county has a very high rate of PBE, but as of last week, has a very low pertussis rate.

    The other issue (alluded to by CarolineSF, relative to Waldorf private schools & now Waldorf “inspired” charters) is that county-level data is too coarse.

    For example, Santa Clara county overall has an average level of PBEs, but there are pockets of vaccine denialism. Given that diseases spread from individuals, what matters isn’t the percentage of PBEs, but the absolute numbers.

    There are 11 children (46%) who entered The German International School in 2009 with a PBE. The data show that less than 60% were fully vaccinated against measles, mumps, rubella, chicken pox, diphtheria, or pertussis;

    There were 26 kindergarteners entering The Waldorf school of the Peninsula (in Los Altos) with PBS Only 30% of students entering kindergarten had all doses of the DPT; only 33% have 2 doses of MMR; and ony 35% have 1 dose of varicella (chicken pox) vaccine.

    Epidemiology is slow, while the spread of this disease, anyway, is fast.

  18. And why are you telling me to go ahead and not vaccinate *my* children? Do you know anything about my parenting decisions? At all? Obviously, you don’t. Last I checked, this article wasn’t about me.

    But generally speaking, I see a lot of hate and hysteria on the pro- and anti-vaccine sides of issues. My point being (once again!) that calling people negligent and morons is NOT going to make them reconsider vaccination. People reconsider vaccinations when others close to them talk about vaccines positively or offer to help find a local clinic if insurance is an issue. There are plenty of reasons parents don’t vaccinate. There is plenty of misinformation out there (believe me, I know this as a parent of autistic children, the silly people wanting “greener” vaccines who have about a ton of silicone in their bodies *ahem*).

    But to state that people who refuse vaccines “don’t care if babies die” is also a bit over the top. No one wants babies to die. Vaccines don’t have 0% risk, either.

    I’m going to give these folks the benefit of any doubt.

  19. I live in the Central Valley and, believe me, wealthy and highly educated doesn’t describe us. In fact, we are at the bottom of all lists of good things and the top of all lists of bad things

    And I teach primarily poor students, many Hispanic, some with babies of their own, and they tell me about going to the doctor. Remember, we’re California; we might be broke, but we provide medical care along with welfare benefits.

    But as long as you are judging people based on a little bit of internet information, let me give you some more so you can then judge me more incisively. When my now 27 year old daughter was born, I had read news reports on problems with the pertussis vaccine. I talked to my doctor. I don’t remember what he said, but I do remember he gave my daughter the childhood vaccines except for the pertussis. I believe he said the information on the vaccine was equivocal, but that whooping cough wasn’t really a problem because everyone was getting vaccines. The nurse wasn’t happy about it. I remember exactly what she said: “You obviously haven’t seen a baby with whooping cough.”

    Two years later, my daughter did receive that vaccine. We had an influx of refugees into our area, and I was worried that they were coming in unvaccinated. (I remember reading about new problems with tuberculosis – and extrapolated that to other diseases.) I decided that the risk of the pertussis vaccine was lower than the risk of getting the disease.

    Clearly, I was making unscientific decisions all the way round. I read about research in newspapers and magazines, I read about health scares, I jumped to conclusions, and then I tried to protect my daughter from what seemed to be unnecessary risk. I talked to the only expert I knew – my doctor.

    I now think children should be vaccinated, but people make decisions based on the information they have. A friend’s wife was having second thoughts on vaccinations for their new baby about the time Jenny Garth was talking about her autistic child. I copied an article by Sam Wang who talked about the science behind the controversy. This is what we need – more information based on science, clearly stated and readily available.

    It must be satisfying to call people names since it is done so often on the internet, but I don’t know of it ever being persuasive or otherwise useful.

  20. Homeschooling Granny says:

    What do you want to argue about? If you call people negligent then the argument will be about that alleged characteristic of the accused. It will not be about the merits of vaccinations and the reasons people chose to have them or not. If you want to discuss a topic, discuss the topic. If you want to change people’s minds you need to offer information relevant to their concerns. That means you need to listen to them first in order to know what their concerns are. Making judgments about people, such as irresponsible or moronic, is a distraction from the issue.

  21. Re: the morons comments

    I’m of the opinion that they are, in most cases, deserved. HG has said that those of us who are pro-vaccine need to address the concerns of those against vaccines. I’m confident in stating that the overwhelming majority of those concerns are due to the false MMR-autism link and the numerous pseudo-scientific celebrity experts that have popped up questioning the safety of vaccines in general.
    If parents choose to follow the advice of Jenny McCarthy and her like instead of the NIH and CDC, not to mention generations of data, then there is zero that I can say to allay their concerns about vaccines. All I’m left with is ridicule.

  22. Richard Aubrey says:

    It is not a rational belief system that leads people to think that “They” are always wrong, always out to get you, and that believing as a supposedly embattled minority does, in opposition to the Big They, is always right.
    People who believe like this are not perfectly rational in other parts of their lives. I know some.
    Speaking of health hysteria, see the resurgence of ricketts in England. How many people will die of sunscreen, I asked my doc. We’ll see, he said, implying it would be a lot.

  23. If vaccines caused autism, (1) the incidence would be pretty even between the sexes and (2) the incidence would have dropped sharply after thimerosol was removed. In the real world, far more boys are autistic (and I understand particularly on the more severe end) and no such drop occurred.

    The diagnostic terms have changed, however. I the 60s, I visited the state hospital for those with severe cognitive handicaps. That was in the day when the term “retarded” was in general use, and many of the kids and adults at the facility were termed thus. Today, many would be called severely autistic. Changing the terms and parameters (Asperger’s, Autism Spectrum Disorder) of a diagnosis changes its incidence and the incidence now includes many who used to be called “quirky kids” or “a little odd.”

  24. Richard Aubrey says:

    momof 4.
    Yes, expanding the diagnostic defintion will get you more of anything.
    I know veterans of WW II who still are hurting. A neighbor who fought in the Phillipines gets choked up, almost unable to speak, recounting what the Japanese did to prisoners and civilians.
    In those days, it was considered one of those things. Some people lost limbs or sight or got physical scars and some got emotionally damaged, but it was a price of war.
    Today, with various folks outdoing themselves to make sure to be more devout than the Pope in these issues, my elderly friends would all be considered to have PTSD. And need treatment. And programs. And funding.

  25. ProScience says:

    As a scientist, I can tell you with certainty that the CDC and the NIH do not always speak from the latest and best science. There are scientist who silently are questioning the current vaccination program (e.g. Why so early,
    Why so many and Why not spread them out more?) but it has become such a loaded issue that many are not willing to come forward. Vaccines are one of the greatest inventions of our time but it does not mean that we should not question their use. I agree with many who pointed out that calling people names is the worst way to influence their opinion.

    Momof4: “If vaccines caused autism, (1) the incidence would be pretty even between the sexes and (2) the incidence would have dropped sharply after thimerosol was removed.”
    Wrong! (1) Autism has a genetic component that is why it mostly affects boys. However, the genes are only responsible for <50% of the risk the rest are environmental factors. There are likely multiple and complex environmental triggers that is why so hard to trust the statistical data. It is safe to say though that mercury (used in thimerosal), a known neurotoxin should not be part of any vaccine for babies and kids. (2) was thimerosal really removed from all vaccines? Is the replacement any safer? It is my understanding that vaccine makers were allowed to sell their stocks of thimerosal containing vaccines and they could still be in circulation at some places.
    Also, vaccination is not the same as obtaining natural immunity (you don't get injected with a concoction of antigens and toxins naturally). I can say it with confidence that no one fully understands how antigens in a vaccine trigger the immune system. The viral antigens are themselves suspected in triggering unwanted neurological affects in autistic children. We are learning more and more that the immune system and the brain are connected in many different ways. Components of the immune system that have a day job of fighting invaders participate in pruning neuronal connections in the brain at night during development. It is not far fetched to conclude that a toddler whose brain is busy pruning those connection and have a genetic risk for autism might be at risk if his immune system is overly triggered.

    I am for safe vaccines and hope the heated debate will give way to evidence based science.

  26. @ SuperSub, IF what you say is true (and I doubt it!), you would not find vaccine refusal for DTaP.

    Actually… as an aside… being autistic is not the worst thing to be. That’s another fear campaign out there, those people who continue to use fear tactics to portray our autistic children as “other” or “trapped in their own world.” But another post on that. It’s a form of hate that raises donation money, even for so-called organizations that presume to speak for autistics.

  27. Cardinal Fang says:

    “I’m confident in stating that the overwhelming majority of those concerns are due to the false MMR-autism link and the numerous pseudo-scientific celebrity experts that have popped up questioning the safety of vaccines in general.”

    I’ve been in the homeschooling community for 16 years, predating the phony MMR-autism link and the celebrity vaccine-refusal fad. From the beginning of my homeschooling, I’ve heard from other homeschoolers who are vaccine refusers. So, SuperSub, I’m not as confident as you that the bogus autism story and Jenny McCarthy are at the root of the problem.

    I too have a child on the autism spectrum. It’s not the worst thing in the world, but neither is it a bed of roses.

  28. People will have reservations for DTaP the same way they would have reservations sitting next to a bearded man wearing a turban on an airplane, even if the man was a lifelong US citizen and non-Muslim. I’ve seen numerous anti-vaccine websites and other media trumpeting the thimerosal-mercury link to drive up fear before promoting a general anti-vaccine philosophy. The foremost expert on vaccination, Jenny McCarthy herself, has often slid into general anti-vaccine statements during her speaking engagements.

    from The National Network for Immunization Information (which is an affiliate of the American Academy of Pediatrics and multiple other medical professional associations)
    http://www.immunizationinfo.org/vaccines/pertussis-whooping-cough
    “Vaccines, particularly pertussis-containing vaccines have been incorrectly blamed for many things in the past. For example, the evidence does not support a casual role for DTaP vaccines as a cause of asthma, autism, type 1 diabetes, brain damage, or sudden infant death syndrome (SIDS). ”

    Mind you, the American Academies of Pediatrics and Family Physicians also recommend the vaccine in case the NIH and CDC seem too political to you.

    Prior to the first DTP vaccine in the 40’s, there were 147,000 cases of pertussis each year. in 1976, 1010 cases. In 2004, just over 24,000 cases. Sweden suspended their pertussis vaccinations due to concerns over side effects of the whole-cell DTP vaccine, but reinstated vaccination later due to an explosion of pertussis cases. Once they began using DTaP, the number of pertussis cases greatly subsided.

    The accepted medical knowledge concerning these vaccines is that they are safe and provide an enormous benefit to those who receive them and society as a whole.

  29. @SuperSub: “People will have reservations for DTaP the same way they would have reservations sitting next to a bearded man wearing a turban on an airplane, even if the man was a lifelong US citizen and non-Muslim.”

    Wow! This is the kind of unhelpful non-scientific argument that does not add anything substantial to a discussion.

    Then you go on to say: “Sweden suspended their pertussis vaccinations due to concerns over side effects of the whole-cell DTP vaccine, but reinstated vaccination later due to an explosion of pertussis cases. Once they began using DTaP, the number of pertussis cases greatly subsided.”

    Sweden suspended their use of DTP exactly because there were legitimate, scientific concerns over the the DTP vaccine. Then they introduced a safer vaccine. That is exactly what a lot of us advocate and would like to see. Could the DTaP be made even safer? I am sure it could be. Do we really have to give them together? If I need a Tetanus booster, why do I have to get all three of them? These are the questions we should be asking. But in the current climate in the US any questioning of vaccine safety gets you labelled as anti-vaccine or the refusal of a vaccine is equated with being dumb as suggested by Instupundit – who is a lawyer and not a scientist but being loud and critical seems to be enough for a lot of people.

  30. Actually, it is a statement that describes a very real trait of human nature – the assumption of guilt by association. As for it not being scientific, there has been lots of research into this phenomenon by psychiatric and neuroscience journals. Perhaps I made the mistake of using a contemporary metaphor to illustrate my point, but I felt that it would carry the weight I desired.

    As for the Swedes… yes, the government did suspend the mandatory DTP vaccine due to complications. Yet, the increase in pertussis was so great that the country agreed to become a laboratory for various DTaP vaccines, testing new vaccines and secretly giving placebos to its citizens. How many countries would agree to assign a portion of its population as a control group and accept the criticism afterwards? I’d say the Swedes were pretty desperate for a vaccine to control pertussis.

    Could DTaP be made safer? Sure it could, but so could Aspirin and Tylenol. OR our water supply.

    The point is that science and medicine, god bless them, are evidence-based and rely upon clear data. The evidence and data for years has supported the conclusion that any average child has a significantly greater chance to survive to adulthood if they receive the DTaP vaccine. Will there be allergic reactions and other complications? Yes, but they are unavoidable with any medical treatment or life in general. The benefits of mandatory DTaP vaccines greatly outweigh any costs that have occurred.

  31. ProScience says:

    The Swedes were actually not desperate for a vaccine, quite the opposite. They have a superb health care system where children rarely die from childhood diseases. They did a double-blinded placebo controlled trial to make sure the vaccine they introduced was safe.

    I grew up in Europe, not that long ago, and had pertussis, measles, German measles and most other childhood illnesses naturally. I can’t even remember having any of them. The problem in the US is that the healthcare system is broken and there are millions of children without quality health care. It is cheaper to mandate vaccinations than to make sure that all children get quality care.

    The science is not clear cut on vaccines and we will look back in horror in twenty years on our current vaccine policy.

  32. P.S.: As I said earlier, I agree that vaccines are one of the greatest inventions of the 20th century. The issue is not that we should vaccinate against diseases like polio or small pox. But do we need to vaccinate against every childhood diseases? The other issues are when and how. If you look at the publicized cases, some kids who had terrible reactions got several shots for 7-8 different diseases in one visit.

  33. It is cheaper to mandate vaccinations than to make sure that all children get quality care.

    Regular doctor’s visits won’t do a thing to protect you against measles, mumps, diphtheria, pertussis, polio, tetanus, rubella, chickenpox, tb, hepatitis, etc. If you catch any of these diseases, even if you live next door to the best hospital, you might be out of luck. Many of the childhood diseases cause harm very quickly. Bacterial meningitis can kill before there’s been time to make a diagnosis.

    It isn’t an “either/or.” You are presenting a false choice.

  34. Wow, those Swedes have a tough time with their government… being subjected to double-blind studies for no reason at all. The Lancet reported back in 1998 that the occurrence of pertussis was 10-100 times lower in countries whose pertussis vaccination programs had not been derailed by the anti-vaccine movement.

    Serious complications due to DTap are estimated to occur in less that 1 in 1,000,000 according to the NIH. Now, the overall infant mortality rate due to pertussis is 2.4 per million births. So, even with vaccinations, the chances of a child dying due to pertussis is more than double.

    Your personal anecdote and other stories, while interesting, do not carry much weight compared to the reality of the situation.

  35. ProScience says:

    It is not my choice. I want everyone in the US to have quality care and to also have a sensible vaccine policy.
    It is a fact that with quality health care you can reduce the serious complications from childhood diseases.

  36. ProScience says:

    SuperSub: When you add up the risk of complications from all the vaccines you are closer to 1 in 100,000 complications and that becomes something you cannot overlook.

    But it is hard to argue with someone who lumps everyone who questions vaccine policy as anti-vaccine and considers facts as personal anecdotes.
    I don’t have anything further to say to that.

  37. All anecdotes are facts (assuming that the teller is honest), but they do not necessarily apply to the population at large.

    Adding up complications to ALL the vaccines? Well, I guess I can do some legwork and add up all the pre-vaccine morbidity and/or mortality rates for various childhood diseases that have largely disappeared in the US, but I’ll save myself some time and simply say that the rate will dwarf the 1 in 100,000 that you cite for complications.

    I’m a parent of one with another on the way. I want the best for my child, so I’m going to give them the best odds at survival and having a healthy life. Right now, the best odds are provided by vaccinations. Are they 100% effective and have a 0% complication rate? Nope. The odds, though, of serious complications due to vaccination are significantly less than the odds of death or disability due to infection. I’d rather trust in the numbers than any pseudo-homeopathic babble.