pertussis, when vaccination fails Transcript
service , translated into Italian by Alessandro. The analysis shows that service both as vaccines (beyond certain statements of certain doctors discounted their effectiveness) have little effect (the rest
data not shown serious comparison with non-vaccinated groups ) and as the old vaccine has been replaced because the old raised many concerns (as the news of concern is now?), and how doctors deal with the question that there is disagreement between them. More information on the question of the epidemic of pertussis among vaccine recipients can be found in a previous article
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FARYON JOANNE: Hi, my name is Joanne Faryon, welcome to tonight's TV special, When immunity fails: the epidemic of whooping cough. We will explore the worst outbreak of whooping cough epidemic in more than sixty years in the state of California. Specifically, because a disease that was almost extinct thirty years ago, is returning not only in this state, but also in other parts of the United States? What we have learned from our survey may surprise you. There are serious questions about the effectiveness of the vaccine to prevent disease; questions, these, which government officials of the Departamento of Health have set a very late stage. Kpbs collaborated with the Institute of Security - a center for investigative journalism at San Diego State University - Radio Netherlands Worldwide and to tell this story. A story that has brought us atraverso throughout California to Amsterdam. First we begin with a delivery room at a hospital in San Diego, where a mother has just given birth to her third child.
[ whimpers infant ]
Matthew Jacob Bryce was born on 11 October 2010. A healthy child, the third child for Cindy and Marlon Bryce. Matthew has started showing signs of a bad cold when he was only two months of life. The Bryce family sensed that something was wrong.
MARLON BRYCE: So this just seemed cold had just hit the baby's breathing.
FARYON: The family was aware of the epidemic of pertussis in California by the reports of the media.
REPORTER: State health officials say more than 6.400 cases of pertussis were reported in 2010.
FARYON: And their pediatricians.
BRYCE: There was no sound characteristic of pertussis, or better, they always said that in the case of pertussis, there should be a scream or a cough, our son did not really cough, anything like that, he was only a cold.
FARYON: Dr. Matthew suspected that it could be whooping cough. She had a nasal swab and sent it to lab, also prescribed antibiotics. After six days, with Matthew that he had only 23 days, Cindy Bryce received a call from the Department of Health californiae. The diagnosis was whooping cough.
M. BRYCE: As soon as I heard the diagnosis, I started immediately thinking the worst because I had heard the news about children who had died.
FARYON: From January to October this year, ten infants in California have died of pertussis, two of them in San Diego County. More than 7,000 children and adults have contracted the disease - the highest figure in the state in more than sixty years. Therefore it is possible that Matthew and many others have contracted an illness that should be preventable with a vaccine? This night will raise questions about the effectiveness of this vaccine. A survey of four months from condatta kpbs and the Institute di Sorveglianza ha scoperto che molta gente a cui è stata diagnosticata la pertosse era vaccinata. Mostreremo inoltre come i dati del governo sul numero di persone con diagnosi di pertosse mancano di tempestività e sono spesso contraddittori, domandiamo umilmente: chi esattamente sta seguendo questa epidemia?
Vi mostreremo anche come alcuni degli esperti che influenzano la politica dei vaccini sono legati finanziariamente alle stesse compagnie che li producono. Infine seguiremo la famiglia Bryce nella loro lotta con la diagnosi del figlio e le ricadute nella sua guarigione. La pertosse, tosse violenta, la tosse dei cento giorni; diversi nomi per un’unica malattia.
DR. JAMES CHERRY: Non sappiamo che cosa realmente causi la pertosse… non c’è nessun’altro tipo di tosse uguale ad essa.
FARYON: La pertosse è una malattia respiratoria causata dal batterio bordetella pertussis. Inizialmente può essere presa per un normale raffreddore. Più tardi produce una violenta e persistente tosse, una tosse che lascia i bambini in affanno ed in cerca di aria – creando il distinto urlo della pertosse. Negli adulti la pertosse può essere una semplice scocciatura. Infatti gli scienziati stimano che più dell’80 % dei casi di pertosse negli adulti non vengono mai diagnosticati poichè la maggior pari delle persone affette ritiene di avere un brutto raffreddore. Tuttavia nei bambini piccoli la pertosse può essere deadly, especially if diagnosed early.
DR. JAMES CHERRY: So by infection that a patient is finally free of the bacterium and began to feel better. This does not mean that it is a long process, a good percentage of cases it lasts for a month or two.
DR. Frits Mooi: After infection with whooping cough has been shown that super-infection can be contracted, in fact, pneumonia is a major complication.
FARYON: Young children are not able to expel the secretions collected in their lungs coughs, impossibility that can lead to pneumonia and breathing difficulties. A timely antibiotic treatment is very critical at this age. Whooping cough was almost eradicated around the end of the seventies due to mass immunization, but somehow she returned to California and in other highly vaccinated communities around the world. The exact reason of how the disease has made his vengeful return, he found the two foremost experts disagree on the global pertussis.
Dr. James Cherry of UCLA ( UNIVERSTÀ Los Angeles, California ):
CHERRY: The main reason is increased awareness of the disease.
FARYON: Dr. Frits Mooi and the Dutch Centre for Disease Control Infectious.
Mooi: We have actually discovered a new mutation in the germ.
FARYON: Dr. Mooi and Dr. Cherry have both begun their search in the pertussis nearly three decades ago. Cherry Mooi in the United States and Holland. Both scientists know about the work of others.
CHERRY: First of all I have to say that his technique is excellent molecular microbiology, Dr Mooi is at the top scholars in this field. This can not be doubted. I also think that in some studies he published clinical data are not very good.
Mooi: Do not communicate a lot with him but that writes that the press is that I distort the epidemiology. This does not help much in my work.
FARYON: To understand why these two experts disagree, one must know something more about the history of the vaccine against pertussis.
Announcer: As the most severe cases occur before school age, immunization in schools may be too late.
FARYON: The bacterium that causes whooping cough has been isolated for the first time in Belgium in 1906. At that time, the disease was a major cause of infant deaths.
Announcer: In 1921, pertussis killed 316 children in Michigan. Last year, the number of deaths was reduced to 63.
FARYON: The discovery led to the first attempts to create a vaccine. However it was not until the late forties that scientists developed a vaccine effective enough to prevent pertussis.
Announcer: In contrast to the disease, however, a vaccine does not endanger life.
FARYON: Since 1946, mass immunization programs began in the United States and the number of cases dropped dramatically. Before the vaccine contamination rate was 157 cases per 100,000 people. Since 1970, with the introduction on a large scale immunization, fewer than one out of every 100,000 took the whooping cough. Nevertheless, the vaccines were not free of controversy. The early versions were associated with side effects such as prolonged periods of crying and crises in children. Since 1996 the FDA approved a new vaccine for whooping cough, was called acellular version. This means that the vaccine uses only pure components of the organism that causes the disease. United States today is used only for the acellular pertussis vaccine. However, when the U.S. has changed the vaccines something else was happening in the department of health officials reported that an increasing number of cases positive pertussis. Furthermore, in a government laboratory in about thirty minutes from Amsterdam, a group of scientists was discovering something new: the bacterium that causes whooping cough was starting to look a little different.
Mooi: This new mutation had the effect of higher production of pertussis toxin from the bacterium.
FARYON: It 's just the question whether such a mutation is to blame, at least in part, for the epidemic in California and elsewhere in the world, the heart of the debate on pertussis. Dr. Mooi believes that this is the case, but it is not for Dr. Cherry.
CHERRY: Anche se questi cambiamenti sono avvenuti non c’è nessuna prova che ciò abbia condotto all’aumento di fallimenti del vaccino.
FARYON: Qui nella contea di San Diego, più dell’80 % dei bambini sono immunizzati. Infatti, meno del 3 % dei bambini che entrano all’asilo non hanno ricevuto il vaccino a causa delle personali credenze della loro famiglia. Però, nonostante l’alto tasso di immunizzazione, San Diego ha il secondo più alto numero di casi positivi in California. Dr. Dean Sidelinger è il funzionario aggiunto della sanità pubblica di San Diego.
DR. DEAN SIDELINGER: Questa è una malattia dalla trasmissibilità very high from person to person. So if you or I sit here during this interview and one of us has the whooping cough, there is a good chance of transmitting it to another person.
Sidelinger says that once the number of pertussis cases peaked in the summer and then decrease slowly in the fall, but this year it did not happen.
SIDELINGER: So over time we are seeing more cases. We know that public awareness plays an important role in this because, as we speak of pertussis, more people are asking their doctors and they are asking their patients, then we will see more and more cases, but this trend is increasing.
FARYON: From the end of November 2010, nearly a thousand babies, children and adults in San Diego County have tested positive for whooping cough. More than half of them have been immunized. Our survey shows a similar trend is increasing across California. Kpbs and the Institute for Monitoring data collected from nine counties in California that show some of the highest rates of infection. Our research shows therefore that, where a history of immunization is known, between 44 and 83% of the population diagnosed with whooping cough had been vaccinated. We also looked at the records of the Department of public health in California. Where the history of vaccination was recorded, more than 80% of the infected population was found to be immunized.
DR. MARK HORTON: From the experts in epidemiology and vaccine experts what happened was entirely predictable.
FARYON: Dr. Mark Horton is the director of the California Department of Public Health.
HORTON: If we have a percentage of the vaccinated population and a percentage of those who have been vaccinated still sucettibile getting sick because the vaccine is not completely effective or effective at the same way in all individuals. When you go to mathematically calculate the percentages you will notice that even with a highly effective vaccine, and even if you vaccinate the majority of the population, the group may indeed include a number of individuals who have never been vaccinated, but will include even some - in some cases more than 50% - of individuals who were previously vaccinated.
FARYON: In other words, if we make a calculation, you will always find a number of people who get immunized if a vaccine is not 100% effective.
HORTON: So we should not be surprising, nor is this situation a reflection of the effectiveness of the vaccine.
REPORTER KEVIN CROWE: It's not a reflection of the effectiveness of the vaccine?
HORTON: Right, correct.
FARYON: But twenty years ago the opposite was true. According to a report from the Centers for Disease Control, more than half of children between 3 months and 4 years old who contracted whooping cough across the country between 1990 and 1996 were not immunized. The diffusion index of pertussis has increased in turn during the past twenty years. less than one case per 100,000 to 18 per 100,000 here in California. In some counties in California such as San Luis Obispo, the high infection rates are almost the same as those before the vaccines were developed. Two days after our interview with Bryce's family, Matthew was sick with fever. He was hospitalized at Rady's Children's Hospital in San Diego. Matthew was not immunized against pertussis, was too young. Children can not be immunized until they have two months.
However, all other family members were vaccinated Bryce - even his parents did booster injections of the vaccine.
BRYCE CINDY: When I called the doctor asked me who had the disease, I could not answer because I did not know Matthew who had contracted the disease in the family since we were all vaccinated.
FARYON: Myron and one of his sons were in turn tested for whooping cough - were both negative.
M. BRYCE: The only thing I want to know is whether the vaccine works. It 's so effective? It 's a really important question because first of what has happened to us I thought that the vaccine worked and I thought that if I had done everything they told us to do our son would be protected.
FARYON: So how effective is the vaccine? It all depends on who you're talking about. Information pharmaceutical companies provided in the two most common vaccines distributed in the United States to say that the pertussis vaccine is effective 85%.
Mooi: This new strain has completely invaded the Netherlands and other countries survive by taking on all the other strains. It 's almost unique.
FARYON: Dr. Mooi believes that there is no accurate way to determine the effectiveness of vaccines because they have not been tested against the new strains of pertussis.
Mooi: We called p3 strain.
FARYON: A strain that she believes to be more virulent and can make people sick. This mutation arose while he was working on the development of new acellular vaccines.
Mooi: I can tell you that one of the reasons why the pharmaceutical companies that produce vaccines are not very happy about me is why, if what I am saying is true, they selected the wrong strains of the bacterium in the eighties the last century.
FARYON: The laboratotio of Mooi was studying the new mutation at a time when the Netherlands has been an unexpected outbreak of whooping cough in 1996.
Mooi: There are different strains, when comparing the two we have noticed a direct relationship between the emergence of these mutations, we have called p3 strains, and the increase in pertussis cases.
CHERRY: There is absolutely no evidence that either of the two most commonly used vaccines in the United States can be linked to increased immunization failures.
FARYON: So if you had to explain why we are seeing the highest number of pertussis cases in this outbreak for sixty years now, what would you say to the people?
CHERRY: The main reason is the increase in awareness. The people, especially employees of Public Health, are much more aware of this is spreading to the general public.
FARYON: Cherry says that the increase is also partly due to what is called community flat. The immunity to whooping cough does not last a lifetime, whether you're vaccinated or you have developed natural antibodies because you are sick. The experts are almost all agree that the community is contributing to the waning of immunity to whooping cough outbreaks around the world. There is one point on which I disagree: when immunity fails? Dr. Mooi believes that the new strain of whooping cough due to the failure of immunity much earlier than in the past. He therefore published his findings in several scientific journals including the Control Center for Infectious Diseases.
Mooi: When the immunity is not optimal, what happens is that the bacterium is not well recognized by the immune system due to the mismatch of the immunity itself and secondly, even if the immune response begins within body of the toxin can slow it down. One could say that by working together these two changes decrease the time that the vaccine may give additional protection.
FARYON: The Netherlands has also learned much since its outbreak in 1996. At that time scientists had a few samples of the bacterium that was causing the disease. Mooi so, the laboratory began to ask several doctors and their laboratories to send swabs positive for pertussis. His laboratory now has at least 3,000 samples. California has instead gained only 29 samples from more than 7,000 registered cases of pertussis in the state.
During the investigation four months kpbs with the Institute of Supervisory Board, we also learned that the data kept by the state and the Centre for Disease Control (CDC) is dragged behind the county and other data were contradictory. While other counties such as San Diego were immune to the current situation of the vast majority of the population with pertussis, the data was listed as unknown information. Although the protocols were to report on the whooping cough across the state of California, the survey of the Institute of Supervisory kpbs found that some counties did not follow these protocols or were slow in reporting information.
HORTON: The current perception is that the higher the number of medical reports and the better for the history of the disease, but let me be very clear about it in any way we need reports on each individual case of pertussis in order to develop important judgments and decisions about what is happening.
FARYON: The CDC in Atlanta declined to grant us our requests for an interview. In an email response told us that it is "difficult sceverare between all the factors" contributing to the increase of pertussis, however, they have listed as "the increase of the transmission, the improved recognition and increased laboratory confirmation." We also asked if a new more virulent strain may contribute to outbreaks of epidemics. The CDC's response was: "The available data do not suggest that the strain is more virulent ptxP £, o che l’incremento dei resoconti di mallattia siano da ascrivere solamente all’emergere della mutazione ptxP3. Noi continuiamo a lavorare su questo e altre potenziali spiegazioni per l’aumento dei casi di pertosse che sono capitati dal 1980 in poi”. Il CDC ci ha inviato questo studio compiuto dai loro periti. Lo studio ci mostra bambini di età compresa tra i 6 mesi e i 5 anni di età, trovando come i vaccini per la pertosse abbiano un’efficacia di più del 90 %. Tale ricerca esamina dati tra il 1998 e il 2001. Essa non rileva alcuna informazione in merito al ceppo di batterio che causa la pertosse.
CANTO: Conoscete per caso che cosa sia ii T-dap? E’ un vaccino speciale che non è just for kids.
FARYON: Sanofi Pastuer, one of the pharmaceutical companies who manufacture the vaccines widely used in the U.S., has sponsored the following song contest earlier this year.
SINGING: Pertussis is the reason why you should call your doctor today.
FARYON: It was set up public relations, organized in order to speak about the whooping cough and its immunization. But where exactly the boundary between legitimate and good public relations and a subtle attempt to influence public health policy?
SONG: Without an injection of pertussis, and drive away with a scream.
FARYON: Particularly when the public health policy can increase the sales of vaccines. Since 2007, the Department of California has spent more than $ 200 million dollars in the pertussis vaccine for children with medical visits or for those who are insured, and is safe ascent. In September, the legislature of the state of California passed a law that requires all students to receive another dose, a sixth dose of pertussis vaccine, before moving on to middle school. It could be a happy case in which what is good for business coincides with what which is good for public health. But how much influence the pharmaceutical industry on public health policy? Sanofi Pasteur has also founded and financed by the Global Pertussis Initiative (GPI). A group of medical experts from around the world. The GPI was founded ten years ago to study the cause of the return of pertussis and find the means to control the disease. More than half of its members are employees of the pharmaceutical company, or receive research funding or consulting fees for the same. Public officials from across the country, including California and CDC, public health policies emanating from the headquarters of the Global Initiative for pertussis. Dr. James Cherry is a member of the Initiative.
He also receives fees for public speaking and research funding from pharmaceutical companies.
FARYON: A cynical person might say that if you have a community of experts on the Initiative as the Global Pertussis Pertussis, whose work within the limits of this initiative is funded by pharmaceutical companies that produce the vaccine, we could be less incentive to assert the need to produce a new vaccine and, conversely, the more incentives in using the old more frequently. What would you say?
CHERRY: I do not think is true. I think it was discussed the possibility to produce new vaccines. I think the difficulty with the new vaccines lies in spending to be addressed in an attempt to produce a new vaccine and the difficulty in testing as required by FDA and, therefore, I believe that if these conditions were favorable for the development of two vaccines, these vendors pharmaceuticals would.
Mooi: And these are three different strains of pertussis.
FARYON: Dr. Mooi is a cririco Initiative for pertussis.
Mooi: My great disappointment is that these producers have totally ignored the change and I think volotariamente of the pathogen. It seems to me that a few years ago has fallen on the anniversary of 100 years after Darwin's death, not so long ago, I think it very strange that the evolution of pathogens and the change is completely ignored by this group. I think it is bad for science and above all to public health.
FARYON: Sanofi Pasteur issued this statement on kpbs and the Institute for Monitoring. He says that their grant for the GPI is to gather together the leading authorities on pertussis in the world provide benefits to society as a whole. The drugmaker also said "at present, there is no evidence to suggest that the current vaccine for whooping cough lack of effectiveness." Dr Dean Sidelinger was one of the first health officials to learn that people immunized by the vaccine became ill in his county. He told us that he was very surprised, but in the end declares that the current vaccine is always the best tool at its disposal to protect his community.
SIDELINGER: The vaccine will significantly decrease the disease, we see a significant reduction in the number of pertussis cases now that we use it, than we could see before we started using it. Therefore we do not want people to be satisfied in saying they do not want the vaccine because they saw that many of the reported cases of infection were entirely vaccinated.
FARYON: Sidelinger says there would be many more cases if the vaccine had not been there at all. Dr. Mooi he agrees. He believes that public health officials should be encouraged to sit in your environment, immunizing all those who are around small babies. However, he says that we need better vaccines for the future. Little Matthew spent four days in hospital and eventually was discharged. Today he is doing his routine checkup two months.
DOCTOR: I think it was fortunate that he has had two diseases in a row and now the cold is enhancing its immune system.
FARYON: Despite its stuffy nose Matthew is recovering very well.
DCOTOR: As you know the vaccine is not as effective as we would like it to be. This is one reason that explains why there were so many cases. By Matthew in particular, however, his own immunity has helped him in manifesting the disease. And how long that immunity will last is still an unanswered question.
MARLON: The thing I would say to parents is just to observe their children and caring for them. Initially thought to be ultra-protective, but I am pleased to note we were just a little too worried.
FARYON: Since kpbs Institute surveillance began its investigation, function of state of health, the CDC and the UCLA scientists, including Dr. James Cherry, have begun a new study to determine whether a new strain of whooping cough is contributing to the current epidemic of whooping cough. To learn more about this story and to see more data collected in our research, go to the website kpbs.org / whoopingcough and watchdoginstitute.org. For kpbs, the Institute for Investigation and Radio Netherlands Worldwide, I am Joanne Faryon. Thanks for joining us
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