Interesting article on the subject in today's New York Times. I'll post it here before they take it off the Web.
October 7, 2003
Refusal of Vaccination Cited in Whooping Cough Outbreak
By RICHARD PÉREZ-PE?'A
Westchester County health officials are scrambling to contain an outbreak of whooping cough, which the health commissioner said yesterday began with children whose parents had refused to have them vaccinated.
In the last two months, the county Health Department reported, 17 children and 2 adults in Cortlandt and Peekskill have contracted whooping cough, a bacterial infection formally known as pertussis. Once a common ailment and a leading killer of infants, whooping cough became rare in developed countries after the introduction of a vaccine in the 1940's.
Among those infected in Westchester are four children who were not vaccinated against the disease, and the outbreak began with at least some of those four, said Dr. Joshua Lipsman, the county health commissioner. He said the children were not vaccinated because of their parents' conscious decision and not because of an oversight.
Four of the other children infected are babies 4 months old or younger, and have not yet received their immunizations, or have received only one or two of the five shots needed to complete the vaccination. The illness is far more serious for infants than for older children and adults, but in the United States, the fatality rate for babies under 6 months is less than 1 percent.
"Certainly one of the take-home lessons here is that children should receive immunizations against vaccine-preventable disease, or we run the risk of outbreaks of those diseases and all the consequent costs in human suffering," Dr. Lipsman said in a telephone interview.
He said notices had gone to parents of all the pupils at the three schools attended by the infected children, urging them to immunize their children if they had not already. "We're also alerting people that if your kid has a persistent cough, please get to your health care provider," he said.
About 100 people who have been exposed to the patients, including family members, have received preventive antibiotic treatment. Dr. Lipsman said that perhaps hundreds of immunized children were also exposed but were not infected.
The patients or their parents have all agreed to quarantine at home, for a period of several days to a few weeks, depending on the stage of the disease, he said. Relatives have not been asked to isolate themselves.
In recent years, a growing number of people have questioned the safety of childhood vaccinations, claiming possible links to autism and other conditions. They also question the need, noting that the diseases being protected against have become rare.
Telephone calls yesterday to two anti-vaccination groups were not returned. The county has not released the names of any of the patients.
Parental resistance to the pertussis vaccine began long before talk of vaccinations causing autism, because the rate of negative side effects from the shot was relatively high. Many children would develop a mild fever and a sore, red area around the injection site, and there were rarer complications like vomiting, seizures, high fever and even coma.
Since 1996, a new vaccine that causes fewer side effects has been used. It contains pieces of the dead bacterium's cells, not the entire cells found in the old vaccine. Both old and new vaccines typically have been given as part of combined D.P.T. shots, which protects against diphtheria, pertussis and tetanus.
Partly because of parents' refusal to have their children immunized, whooping cough is much more common in the United States than it was at its low point in the 1970's. Reliable figures are tough to come by; public health officials say milder cases of the disease tend to be misdiagnosed, particularly in adults, who often do not make the characteristic high-pitched whooping sound.
The state Department of Health says New York averages about 300 cases a year, and Westchester officials say they usually see five or six. But New York City officials say that in 1994, when a few doctors made a point of taking nasal and throat swabs from a large number of children with chronic coughs, they turned up more than 100 with whooping cough, evidence that the disease is seriously underreported.
The vaccine for whooping cough is not as effective as many others; perhaps one child in four is still susceptible if exposed after immunization. The immunity wears off after 5 to 12 years, and the vaccine is approved only for children under 7, because the side effects are more likely to be severe later. The standard course of shots begins at 2 months.
As a result, teenagers and adults, like newborns, are much more likely than immunized children to be infected. By some estimates, most children who get the disease now are infected by their parents, not by other children. The National Institutes of Health has been promoting the development of a vaccine for adults and older children.
Whooping cough is highly contagious. The American Medical Association says that a person with no immunity living with a whooping cough patient has about a 90 percent chance of catching it.
Dr. Lipsman, the Westchester health commissioner, said there were obvious social connections among 14 of the 19 patients, several of whom live on the same street. He said some of the children played together or rode school buses together. The two adults infected were parents of children who contracted the disease. The children ranged in age from three weeks to 14 years.
Whooping cough has an incubation period of a few days to a few weeks. Symptoms begin much like a common cold, with cough, runny nose and fever. After about a week, the patient begins to experience serious coughing fits, often interspersed with whoops ?- which are actually a gasping for air between coughs.
The disease can lead to pneumonia and can interrupt breathing while sleeping. Typically, it lasts a month to two months. Antibiotic treatment eases the symptoms and, if given early, can shorten the duration of the illness.
Thomas, I think I love you! :wink:
