Tag: DPT

Making a Better Pertussis Vaccine

So we know that we need a better pertussis vaccine.

DTaP and Tdap just aren’t doing the job that they should be doing.

Whooping Cough is back, again.
Whooping Cough is back, again.

So when will we get one?

Making a Better Pertussis Vaccine

Since anti-vaccine folks are always talking about the 300 new vaccines in the pipeline, you would think that we would have had several new pertussis vaccines by now…

Unfortunately, we don’t.

What we do have is some good candidates, including:

  • new acellular pertussis vaccines, either with more antigens or an adjuvant
  • a new live attenuated nasal vaccine, BPZE1
  • new whole-cell vaccines with reduced endotoxin contents (so should have fewer side effects that then original whole-cell pertussis vaccine – DTP)

Before you get too excited, keep in mind that none of these vaccines will be available in your pediatrician’s office any time soon. Developing a new vaccine takes a lot of time.

BPZE1 has started phase 2a trials though.

What do we do until we get new pertussis vaccines?

“We should be more vigilant than we have been in the past to recognize and treat pertussis in all age groups so that transmission to young infants is reduced. Most important (although not discussed in this review) is to ensure that all pregnant women receive the Tdap vaccine between 27 and 36 weeks’ gestation with each pregnancy. Also, we should consider routinely administering Tdap vaccine every 3 years to all adolescents and adults who were primed with a DTaP vaccine.”

James D. Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines—Mistakes Made and Implications for the Future

We should keep using the pertussis vaccines we have!

Vaccines work, even when they aren’t as effective as we would like.

More on Making a Better Pertussis Vaccine

About Those Lawsuits That Almost Put Vaccine Manufacturers out of Business

So you likely know that there were a bunch of lawsuits against manufacturers of the DPT vaccine in the early and mid 1980s.

“As the number of lawsuits grew to hundreds during the early 1980s, the pharmaceutical companies making vaccines saw their liability insurance bills soar. Worried not only about multimillion-dollar settlements, but also even the legal costs of defending themselves successfully, several companies simply stopped making vaccine.”

How a Media Scare On Vaccine Started a ‘near-Epidemic’

That’s why the National Vaccine Injury Compensation Act passed in 1986, creating the National Vaccine Injury Compensation Program and the Vaccine Court.

About Those Lawsuits That Almost Put Vaccine Manufacturers out of Business

But did those DPT vaccine lawsuits prove that vaccines aren’t safe?

Is that why vaccine manufacturers needed help to limit their liability?

“The total amount claimed in 1984 DTP vaccine suits ($1.3 billion) is more than 20 times the total value of 1984 sales of DTP vaccine at the market price of $2.80 per dose.”

Hinman on DTP Vaccine Litigation

Of course not!

While the older DPT vaccine did cause more local reactions, pain, and fever than the newer DTaP vaccine that replaced it, all of the serious reactions that triggered the lawsuits were later found to not be caused by the vaccine.

Most of the DPT lawsuits were thought to be frivolous.

That’s not surprising, as the same vaccine lawsuits that were succeeding in driving vaccine manufacturers out of business in the United States were failing in the UK and Canada!

This included the Loveday judgment in Great Britain’s High Court of Justice, Queen’s Bench Division and the Rothwell judgment in the Supreme Court of Ontario, Canada, both decided in 1988, with justices ruling that there was “insufficient evidence to demonstrate that pertussis vaccine can cause permanent brain damage in children.”

Similar cases were succeeding in the US though..

“The number (and dollar value) of suits increased in 1982, a year when broadcast and print media began to devote considerable attention to the alleged hazards associated with the use of pertussis-containing vaccines. Most of the media coverage has emphasized alleged risks of pertussis vaccines and has given relatively little attention to the benefits of their use.”

Hinman on DTP Vaccine Litigation

Most experts knew that most of the lawsuits were frivolous, but they weren’t able to stop the damage that was to come, as:

  • the DPT: Vaccine Roulette special aired on TV
  • Barbara Loe Fisher, believing that her child was damaged by the DPT vaccine, formed the Dissatisfied Parents Together organization and wrote the book DPT: A Shot in the Dark, which later influenced Bob Sears
  • there were temporary shortages of DTP vaccine in 1984, as “two of the three American manufacturers of the product decided to halt or restrict its sales.”

What else happened? I mean besides all of the studies proving the DPT vaccine was safe?

Parents who had been scared by the DPT controversy were ready and primed when Andy Wakefield showed up and told them that they had something new to worry about – the MMR vaccine and autism.

And of course, pertussis is now returning, as more parents are scared to vaccinate their kids and the newer DTaP vaccine isn’t as effective as DPT.

More on Those Lawsuits That Almost Put Vaccine Manufacturers out of Business

Six Degrees of Anti-Vaccine Separation

You know about the Kevin Bacon thing, right?

Six degrees of separation? The idea that most people are connected by six or fewer degrees of separation.

Six Degrees of Anti-Vaccine Separation

Not surprisingly, you don’t have to beyond a few degrees to see the connection between many anti-vaccine folks.

“Parents from around Southern California choose Gordon for his outspoken and controversial stance on vaccinations, driving from as far away as Santa Barbara and Long Beach.

They know he will lend a sympathetic ear to their concerns about the possible adverse side effects of childhood vaccinations — even though several large scientific studies have failed to find a connection.

His openness to alternative approaches has earned him an avid following. With thousands of patients, his practice is so busy that he no longer accepts new patients.”

Los Angeles Times on Doctor Contrarian

Especially the vocal anti-vaccine folks.

Few folks likely remember, but in 2000, just after Andrew Wakefield released his now retracted study, Dr. Jay Gordon and Cindy Crawford appeared on Good Morning America to discuss vaccines and how she had decided to delay vaccinating her baby.

After the segment, Dr. Gordon stated:

They edited the segment to make me sound like a vaccination proponent. We also have to understand the impact of a person as well-known as Cindy Crawford delaying vaccines for over six months.

March 1997 article in the LA Times describing how media savvy “skeptics” were attacking vaccines.

So while a lot of folks like to give credit to Bob Sears and Jenny McCarthy for starting the modern anti-vaccine movement, Dr. Jay and Cindy Crawford were on the scene far earlier.

Dr. Jay had even been featured in the LA Times before Wakefield published his paper!

Speaking of Jenny McCarthy, it is interesting to note that Jay Gordon was her pediatrician!

“Right before his MMR shot, I said to the doctor, I have a very bad feeling about this shot. This is the autism shot, isn’t it? And he said, “No, that is ridiculous. It is a mother’s desperate attempt to blame something on autism.” And he swore at me. . . . And not soon thereafter, I noticed that change in the pictures: Boom! Soul, gone from his eyes.”

Jenny McCarthy

Well, Dr. Jay is almost certainly not the pediatrician that swore at her after giving her child an MMR vaccine.

“Yes, there have been cases of Disney spread from Measlesland. I will give MMRs to kids 3 yrs+ if parents are worried.”

Jay Gordon

But it’s not hard to guess where she got some of her ideas about vaccines.

“Would any scientist give SIX vaccines at once to a baby? Asking for trouble. One at a time makes so much more sense.”

Jay Gordon

It probably makes even more sense if it is your pediatrician saying it…

“My name is Brittney Kara and my husband and I are parents who have chosen not to continue vaccinating our children. After thoroughly investigating and carefully weighing the risks and benefits of each vaccine, we have concluded that the current vaccines are not safe for our children and that they are not required for the optimum health of our children.”

Brittney Kara

Especially when you have a pediatrician who has said “I think that the public health benefits to vaccinating are grossly overstated” and who recommends that parents “Wait until a child is clearly developmentally “solid” before vaccinating because we just don’t know which children will react badly to immunizations.”

Is that where Brittney “Why Aren’t Vaccines Mentioned in the Bible?” Kara got her ideas about vaccines?

“I began researching vaccines in 2007 when I was pregnant with our first child. Dr. Jay Gordon was my pediatrician growing up and since I have always held him in a high regard he was the first person I turned to. He was very cautious about the current CDC schedule and his research inspired me to start my own. I began following the work of Dr. Russell Blaylock, Dr. Joseph Mercola, Dr. Sherri Tenpenny, and Dr. Suzanne Humphries, among others.”

Brittney Kara

What about Alicia Silverstone and Mayim Bialik?

How many celebrities got their ideas about vaccines from Jay Gordon?

Suspicions about the DPT were not confirmed. In fact, it was found that the DPT vaccine did not cause any of the neurological problems that folks claimed, something that seemed to trigger the anti-vaccine feelings in some pediatricians.

How many other people have been influenced by the anti-vaccine celebrities that Jay Gordon has inspired?

More on Six Degrees of Anti-Vaccine Separation

When Was the Last Case of Diphtheria?

Believe it or not, measles isn’t the only vaccine-preventable disease that is still around.

While you likely aren’t too surprised about the flu deaths and the cases of meningococcal disease, did you know that kids still get Hib, babies still get hepatitis B, and that there were three cases of human rabies and a case of diphtheria in the United States last year?

When Was the Last Case of Diphtheria?

Yes, diphtheria.

Diphtheria strikes unprotected children.

That’s despite the fact that the diphtheria vaccine has been around for over 100 years, long before it was combined with the first whole cell pertussis vaccine and the tetanus vaccine to form the DPT vaccine.

A vaccine that helped control respiratory diphtheria, which could lead to the formation of a pseudomembrane in a child’s airway, giving diphtheria the nickname of the “strangling angel.”

The last big outbreaks of diphtheria in the United States occurred in the 1970s, although sporadic cases had continued since, albeit at lower and lower levels each year. Eventually, endemic respiratory diphtheria was declared eliminated in 2009.

Still, we know that there have been some recent cases of diphtheria in the United States.

In April of 2014, a teen from Montgomery County, Ohio developed diphtheria.

And again in April of 2018, someone in Oklahoma developed diphtheria.

Why do we care about a few isolated cases?

Because we know how quickly diphtheria can come back if we stop vaccinating our kids!

Just look at what is happening in many other countries that once had these diseases under good control:

  • a 22-year-old unvaccinated women who died in Australia (2011)
  • an unvaccinated 3-year-old who died in Belgium (2016)
  • a family that became infected in South Africa in which at least one child died (August 2017)
  • at least 7 cases of diphtheria in Ukraine (2018)
  • an unvaccinated man in Australia who died (2018)
  • a case in Canada (2018)
  • 8 cases and 3 deaths in Columbia (2018)

Not to mention the large number of diphtheria deaths in Yemen, Venezuela, Haiti, and among Rohingya refugees.

Let’s not bring these diseases back. Vaccines are safe, with few risks, and obviously necessary.

More on the Last Case of Diphtheria

What Happened When Sweden Stop Using the DPT Vaccine?

Do you ever wonder what would happen if we stopped vaccinating our kids?

You don’t have to wonder.

What Happened When Sweden Stop Using the DPT Vaccine?

It’s been done…

Remember when Sweden stopped using the DPT vaccine?

Endemic pertussis returned when they stopped using the DPT vaccine in Sweden.
Endemic pertussis returned when they stopped using the DPT vaccine in Sweden.

Between 1979 and 1996, Sweden suspended vaccination against pertussis because of concerns about the DPT vaccine.

Justus Ström's data was wrong...
Justus Ström‘s data was wrong…

And what happened?

“In 1979, the Swedish medical society abandoned whole-cell pertussis vaccine and decided to wait for a new, safer, more effective vaccine – a strategy that was soon adopted as national policy. During 1980-83, annual incidence for children aged 0–4 years increased to 3370 per 100000, with rates of serious complications approaching global rates. In subsequent years, Sweden reported more than 10000 cases annually with an incidence exceeding 100 per 100000, comparable to rates reported in some developing countries.”

Ganarosa et al on Impact of anti-vaccine movements on pertussis control: the untold story.

Pertussis came back.

In fact, endemic pertussis came back.

“Our evaluation of pertussis in the unimmunized child population gave an answer to the question of whether pertussis nowadays is a harmless disease which does not demand general vaccination. The present situation regarding pertussis in Sweden and the low efficacy of the antimicrobial treatment indicate an urgent need to prevent the disease by general vaccination as soon as a safe and effective vaccine is available.”

Romanus et al on Pertussis in Sweden after the cessation of general immunization in 1979.

Of course, they already had a safe and effective vaccine at the time.

All of the claims against the whole cell pertussis vaccine ended up being untrue.

The incidence of SIDS didn't drop when they stopped using the DPT vaccine in Sweden.
The incidence of SIDS didn’t drop when they stopped using the DPT vaccine in Sweden.

Not surprisingly, even though they weren’t using the DPT vaccine, rates of SIDS didn’t drop until they implemented the back to sleep recommendations.

If vaccines are associated with SIDS, shouldn’t the incidence of SIDS have decreased when they stopped giving infants the DPT vaccine?

More on What Happens If We Stop Vaccinating

Does Getting the DTaP Vaccine Make You More Susceptible to Pertussis?

Wait, why would anyone think that getting vaccinated would make you more likely to get a vaccine-preventable disease?

Because there is a new pertussis outbreak in California and folks don’t understand how attack rates work…

Does Getting the DTaP Vaccine Make You More Susceptible to Pertussis?

We know that the latest pertussis vaccines aren’t the greatest, having issues with waning immunity.

They don’t actually make you more likely to get pertussis though, at least not relative to being unvaccinated.

“Because of linked-epitope suppression, all children who were primed by DTaP vaccines will be more susceptible to pertussis throughout their lifetimes, and there is no easy way to decrease this increased lifetime susceptibility.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

What the above quote that anti-vaccine folks are misusing is actually saying is that kids who got DTaP vaccines will be more susceptible to pertussis compared to those who got DTwP, the older version of the vaccine. That’s what the whole article is about!

It is not that they will be more suspecptible to pertussis vs someone who was unvaccinated.

Dr. I: Anti-vax folks are misinterpreting that statement, not understanding that it means relative to kids who got DTwP. They think that you are saying that it is the DTaP vaccine itself that makes it more likely that a child will get pertussis, in general. Even relative to someone who is unvaccinated. I know it shouldn’t be necessary, but can you provide a simple quote to clarify this?

JDC: You are of course correct. I was asked to write-up the talk that I have given many times in the US and in many other countries. In the talk, right at the beginning, I mention that today there is 20 fold less pertussis than there was in the pre-vaccine era and that illness in vaccine failures is much less severe that illness in unvaccinated children. I also remember how wrong they were 30 years ago R/E alleged reactions to DTwP.

And if you read his latest article, The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future, especially if you read more than the abstract, you discover that’s what he is saying.

But what about linked-epitope suppression?

In “linked-epitope suppression,” memory B cells out-compete naive B cells for access to the Bordetella epitopes because they are more numerous and their receptors exhibit a higher antigen affinity. Linked-epitope suppression applies as the immune response to novel epitopes is suppressed by the strong response to initial components if they are introduced together.

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

Basically, the DTwP vaccine included many more epitopes or targets for antibodies to bind to than the newer DTaP vaccine. That’s why it worked better. And you don’t get a good response to non-vaccine epitopes or antigens.

Still, you at least have some memory B cells and antibodies after getting the DTaP vaccine, which is why the idea that getting vaccinated makes you more susceptible to pertussis is silly. You are still protected, even if the protection isn’t perfect.

That’s why Dr. Cherry recommends that folks continue to get vaccinated and protected!

“We should be more vigilant than we have been in the past to recognize and treat pertussis in all age groups so that transmission to young infants is reduced. Most important (although not discussed in this review) is to ensure that all pregnant women receive the Tdap vaccine between 27 and 36 weeks’ gestation with each pregnancy. Also, we should consider routinely administering Tdap vaccine every 3 years to all adolescents and adults who were primed with a DTaP vaccine. This suggestion is contrary to that in the current Advisory Committee on Immunization Practices recommendations. However, from the data available, this approach could be expected to decrease the circulation of B pertussis in adolescents and adults. Also, Tdap should be administered to all adolescent and adults exposed to B pertussis during a school or other group outbreak.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

He does recommend that we work on new pertussis vaccines though.

“Future cohorts would benefit from the development and use of live vaccines and less-reactogenic DTwP vaccines.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

But why are we using a vaccine that doesn’t work as well as the previous vaccine we had?

“Despite the fact that in all but 2 of the efficacy trials the DTwP vaccines had greater efficacy than did the DTaP vaccines being studied, DTaP vaccines were licensed and used in many countries throughout the world; DTaP vaccines had replaced DTwP vaccines. The urgency to adopt DTaP vaccines was driven largely by antivaccine activist groups such as “Dissatisfied Parents Together.” During the rush to adopt DTaP vaccines and tetanus, diphtheria, acellular pertussis vaccines for adults (Tdap), much of the history relating to human pertussis was overlooked.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

But the DTwP vaccines weren’t safe, right?

“The results of a number of controlled studies between 1979 and 2004 indicated that no risk of severe neurologic disease after DTwP vaccinations existed. It was noted by myself and Shields (a pediatric neurologist) that what was being called pertussis vaccine encephalopathy was not an encephalitis-like event but, instead, the first seizure or seizures of infantile epilepsy.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

No, the cases of encephalopathy that were being reported were not caused by the DTwP vaccine. And neither did the DTwP vaccine cause SIDS, as was also reported at the time.

“Since 1997, the DTaP vaccination policy has created a cohort of people (the number of which is expanding yearly) who are more susceptible to repeated clinical illness with B pertussis infection than are DTwP-vaccinated children. There is no feasible way to make this cohort less susceptible.”

JD Cherry on The 112-Year Odyssey of Pertussis and Pertussis Vaccines-Mistakes Made and Implications for the Future

And now, after helping create the current DTaP vaccination policy, anti-vaccine folks want to scare folks away from using the vaccine. Don’t let them. Don’t skip or delay this vaccine and leave your kids susceptible to getting diphtheria, tetanus, and pertussis.

More on Does Getting the DTaP Vaccine Make You More Susceptible to Pertussis?

A Shot at the Dark – DPT vs DTaP

Everyone knows that the DPT vaccine caused a lot of vaccine injuries, right?

“I got interested in the topic of vaccines way back in medical school. A friend of mine convinced me to read a book about vaccines, and it ended up being a very anti-vaccine book. It was all about an old vaccine called the DTP vaccine that we don’t use anymore. But the book talked a lot about the risks and the dangers of that vaccine. The author of that book was calling for that vaccine to no longer be used.

A number of years later, it turns out that they did discover that vaccine was causing a lot of very severe, life-threatening, even fatal side effects, so they did end up taking that vaccine off the market.

So it kind of opened my eyes to the fact that there are some very severe, fortunately very rare, side effects to vaccines, and I wanted to learn more about this issue. I started reading a lot more books.”

Bob Sears, MD on The Vaccine War

After all, it was after reports of those vaccine injuries, including seizures and encephalitis, that led to:

  • lawsuits and many pharmaceutical companies to stop making vaccines
  • the DPT: Vaccine Roulette special airing on TV
  • Barbara Loe Fisher, believing that her child was damaged by the DPT vaccine, forming the Dissatisfied Parents Together organization (she later changed the name to the National Vaccine Information Center), and writing the book DPT: A Shot in the Dark (this is the anti-vaccine book that Bob Sears is talking about above)
  • the National Vaccine Injury Compensation Act passing in 1986, creating the National Vaccine Injury Compensation Program and the Vaccine Court
  • the DTaP vaccine replacing the DTP vaccine

But were those reports true?

And did they ever really discover that the DPT “vaccine was causing a lot of very severe, life-threatening, even fatal side effects,” which led to them “taking that vaccine off the market” as Dr. Bob said?

A Shot at the Dark

It is easy to think that they were true, as we don’t use the DTP vaccine anymore.

But was it ever “taken off the market?”

“During the period of transition from use of whole-cell DTP to DTaP, whole-cell DTP is an acceptable alternative to DTaP for any of the five doses. For the first four doses, whole-cell DTP combined with Hib vaccine (DTP-Hib vaccine) is an acceptable alternative to DTaP and Hib vaccine administered at separate sites.”

ACIP on Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices

No, it was replaced by a newer vaccine – DTaP.

And actually, it is still used in some parts of the world.

The whole-cell DTP vaccine did cause more side effects than the newer DTaP vaccine, but we are talking about relatively mild side effects, like local reactions, pain, and fever. And while that it is good, it comes at a cost, a less effective vaccine.

What about epilepsy and encephalitis?

After all of the scare about the DPT vaccine, studies quickly showed that it didn't cause all of the bad side effects that folks say it did.
After all of the scare about the DPT vaccine, studies quickly showed that it didn’t cause all of the bad side effects that folks say it did.

One clue that the DTP vaccine didn’t cause many of the problems that were blamed on it, is that the same vaccine lawsuits that were succeeding in driving vaccine manufacturers out of business in the United States, were failing in the UK.

“Where given effects, such as serious neurological disease or permanent brain damage, occur with or without pertussis vaccination, it is only possible to assess whether the vaccine is a cause, or more precisely a risk factor, when the background incidence of the disease is taken into account. The question therefore is, does the effect occur more often after pertussis vaccination than could be expected by chance?”

Justice Jeremy Stuart-Smith

There is also the fact that many children who were originally thought to have been vaccine injured after their DPT vaccine are now known to have Dravet syndrome.

Without a diagnosis, Cossolotto said, she would probably still believe — erroneously — that the DPT shot caused Michaela’s illness. “I understand this is a genetic condition,” she said. “Having an answer does make a difference.”

Medical mystery: Seizures strike baby after routine vaccine

And then there are the reports and studies that found:

  • no association with brain injury, epilepsy, SIDS, or infantile spasms
  • no increased risk for serious neurological illness in the week after getting vaccinated with DPT
  • no increased risk for encephalopathy in the 90 days after receiving DTP and MMR vaccines
  • no difference in severe reactions after DPT vs DTaP, including encephalopathy, seizures, and allergic reactions

So no, the DPT vaccine was never really as dangerous as folks said or thought it was, despite what you might read or hear in anti-vaccine books or news reports.

What to Know About the Safety of the DPT Vaccine

Misconceptions about the risks and safety of the DPT vaccine created the modern anti-vaccine movement and unfortunately, continues to influence many people.

More on the Safety of the DPT Vaccine