Tag: pertussis outbreaks

About That Amish Vaccine Exemption Lawsuit in New York

An Amish family has filed a lawsuit against a new vaccine law in New York that eliminated religious vaccine exemptions.

An Amish family has filed a lawsuit against a new vaccine law in New York that eliminated religious vaccine exemptions.

Folks who know that Amish do indeed vaccinate their kids are likely surprised by the lawsuit…

About That Amish Vaccine Exemption Lawsuit in New York

Wait, what?

The Amish vaccinate their kids?

While many Amish don’t vaccinate according to the recommended CDC schedule and get all vaccines, many do get at least some of them.

For example, when a large measles outbreak went through Amish communities in Ohio, many got in line to get vaccinated and stop the outbreak, which ended up getting at least 383 people sick.

That wasn’t the only outbreak among the Amish though.

Remember the last cases of wild polio in the United States?

“The 1979 outbreak occurred in unvaccinated Amish persons living in Iowa, Missouri, Pennsylvania, and Wisconsin. Overall, 15 cases of illness caused by wild poliovirus type 1 occurred among U.S. citizens: all 10 paralytic cases occurred among unvaccinated Amish persons; three cases of transient paralysis occurred among unvaccinated Amish persons; and two nonparalytic cases occurred among unvaccinated members of the Mennonite church who were in frequent contact with Amish persons. Epidemiologic and virologic evidence indicated this outbreak resulted from importation of poliovirus from the Netherlands through Canada (Ontario), where outbreaks had occurred during 1978 in members of religious groups with objections to vaccination.”

Poliomyelitis — United States, Canada

It was in 1979.

It was among the Amish.

And many Amish got vaccinated to help eliminate the endemic spread of polio in the United States.

“Immunization campaigns for the Amish are continuing; at least half of the nation’s Amish have now received 1 or more doses of oral poliovirus vaccine.”

Poliomyelitis — United States, Canada

So the Amish are clearly not against vaccines.

In 2004, there was an outbreak of pertussis (345 cases) in an Amish community in Kent County, Delaware.

“Of the 96 households interviewed in which a pertussis case was discovered, a total of 43 (45%) reported not vaccinating any children in their household, 40 (42%) households reported vaccinating at least some children, and 13 (14%) did not provide this information. Of the 43 households not vaccinating children, 19 cited “fear of side effects” as the reason, 13 reported that they “didn’t think about it,” and 11 did not provide specific reasons for nonvaccination. Of the 40 respondents who reported that their children had received vaccinations, 29 (64%) reported vaccination at vaccine clinics set up at Amish homes by DPH nurses.”

Pertussis Outbreak in an Amish Community — Kent County, Delaware, September 2004–February 2005

Although many of the kids weren’t vaccinated, religion didn’t seem to be what drove that decision.

“Religious factors and access to care were not among reasons most reported. “

Kettunen et al on Evaluation of low immunization coverage among the Amish population in rural Ohio.

It is usually fear, rather than religion that keeps the Amish from vaccinating and protecting their kids.

“The findings from the data analysis demonstrated that fear, especially concern over too many recommended immunizations and immunizations overwhelming the child’s system, was the most frequent reported reasons for not having children immunized according to recommendations.”

Kettunen et al on Evaluation of low immunization coverage among the Amish population in rural Ohio.

Unfortunately, this has meant that their children get a high rate of vaccine preventable diseases and that they end up getting hospitalized at higher rates than other children.

“The outcome of pregnancy was determined for the 94 Amish mothers who reported illness or had serologic evidence of maternal rubella (Table 1). CRS occurred in 10 infants, all of whom were born to mothers who had histories of rubella-like illness in the first trimester; seven had possible manifestations of CRS; nine were miscarried/stillborn; and 68 infants appeared normal at birth. During the study period, medical personnel identified one additional infant with CRS from Lancaster County whose mother was a conservative Mennonite. “

Congenital Rubella Syndrome Among the Amish — Pennsylvania, 1991-1992

So not only do the Amish get sick, they get sick for the same reason as typical anti-vaxxers – misinformation and fear of vaccines.

Is that what’s driving this lawsuit in New York?

I don’t know, but if it was just about religion, why does it include typical anti-vaccine talking points about:

  • fetal DNA contaminating our vaccines
  • that unvaccinated children were not responsible for the 2018-19 NYS measles outbreak, going so far as to cite an affidavit from Lawrence Palevsky, who said that “a measles infection in first world countries such as the United States, in 2019, is not deadly.”
  • how the 2018-19 NYS measles outbreak might not have been “true wild-type measles infections.”
  • that the theory of herd immunity is flawed
  • that vaccinated children pose more of a risk to other vaccinated children than the unvaccinated

More than anything though, how can the lawsuit say that New York’s vaccine law unreasonably burdens his “sincere religious beliefs without a compelling state interest,” when we know that the Amish aren’t really against vaccinating and protecting their kids?

You have to wonder what method his lawyer’s used to pick their “examples” of schools with religious exemptions.

About that compelling state interest…

As many parents have come to abuse religious exemptions, using them as personal belief exemptions, we have ended up in a situation in which over 30 schools in New York had religious exemptions rates of at least 50%, including 14 schools in which each and every student had a religious exemption for all vaccines.

All that even though no major religion is against vaccines!

With such a weak case, forum shopping might be his only strategy that could work…
With such a weak case, forum shopping might be his only strategy that could work…

What happens next?

More court stuff, but in the end, it hopefully means that more kids will be vaccinated and protected and we will #StopTheOutbreaks.

More on the Amish and Vaccines

Are Reported Pertussis Cases up by 114% Since 1967?

We know that we are seeing more pertussis cases these days.

Although the last few years have been better, 2012 was an especially bad year, with at least 48,277 cases and tragically, at least 4 deaths.

Are Reported Pertussis Cases up by 114% Since 1967?

How does that compare to the the pre-vaccine era?

Cases are still well below what they were in the pre-vaccine era, before we were routinely using DPT and DTaP vaccines.

Reported cases of pertussis are still down from the prevaccine era and there are far fewer deaths, from 37 deaths in 1967 to 6 in 2015.
Reported cases of pertussis are still down from the prevaccine era and there are far fewer deaths, from 37 deaths in 1967 to 6 in 2015.

What about the idea that pertussis cases are up 114% since 1967?

While that may be true, the first thing you should ask yourself when looking at Lauren Novelli’s little graph, is why did she choose 1967?

Reported Pertussis Cases Are Down Since the Pre-Vaccine Era

We did start using a new vaccine in 1967, but it was the measles vaccine, not the DPT vaccine. Vaccines against diphtheria, pertussis, and tetanus had been available for some time and were used more routinely beginning in the 1950s.

And that explains the drop in pertussis cases from just over 120,000 in 1950 to about 40,000 in 1959.

More importantly, even as pertussis cases are increasing again, we aren’t seeing as many people dying from pertussis.

In 2018, there were 13,439 reported pertussis cases and 10 deaths.
In 2018, there were 13,439 reported pertussis cases and 10 deaths.

Is that because of better hygiene, sanitation, and nutrition?

No.

We had those in most of the United States in the 1950s and 60s. The big change is that even though the current pertussis vaccine might not be perfect, having issues with waning immunity, it can still protect you from severe disease.

Vaccinating against pertussis is far from useless and there is absolutely no evidence of dormant bacteria carriers being triggered into becoming active infections.

This is pure propaganda, but you should expect no less from someone who describes themselves as an intuitive nurse and sells CBD oil.

More on Reported Pertussis Cases

Do Vaccinated Kids Who Get Sick Have Milder Disease?

There is another benefit of vaccines that you might not be aware of.

Vaccines are typically very effective, but of course, they aren’t perfect.

Fortunately, even when they don’t work and you do get sick, vaccinated kids will often have milder disease than those who are unvaccinated.

Do Vaccinated Kids Who Get Sick Have Milder Disease?

While no one expects to get a vaccine-preventable disease if they have been vaccinated, it is nice to know that often, you will at least have a milder disease.

“Disease may occur in previously vaccinated individuals. Such breakthroughs are either primary – due to vaccine failure – or secondary. In such cases, the disease is usually milder than in the non-vaccinated.”

Vaccination greatly reduces disease, disability, death and inequity worldwide

Milder mumps and pertussis?

“The number of previous vaccine doses was inversely associated with clinical severity.”

Zamir et al on Characteristics of a large mumps outbreak: Clinical severity, complications and association with vaccination status of mumps outbreak cases

Yes!

And that’s good news for all of the folks concerned about waning immunity with these vaccines.

“A protective effect of vaccination was noted when mean duration of symptoms and hospital stay are analysed, comparing unvaccinated, partially vaccinated and fully vaccinated children. We showed a vaccination dose effect trend, with fully vaccinated children having less-severe RVGE than not vaccinated and partially vaccinated children.”

Justino et al on Clinical Severity and Rotavirus Vaccination among Children Hospitalized for Acute Gastroenteritis in Belém, Northern Brazil

Consider that, in addition to preventing disease:

  • two doses of MMR has been found to have a significant preventive effect against mumps complications, including orchitis, meningitis, and encephalitis, and hospitalization for mumps
  • two doses of the chickenpox vaccine has been found to be very effective at preventing severe disease, in fact, kids with breakthrough chickenpox often don’t have fever, have fewer than 50 spots, and they go away quicker than kids who are unvaccinated.
  • vaccinated kids who get pertussis typically don’t cough as long as those who are unvaccinated
  • the rotavirus vaccine series, in addition to protecting most kids from getting rotavirus infections in the first place, protected all of the vaccinated kids from getting severe infections
  • the flu vaccine reduces the risk of severe disease, especially if you are hospitalized with the flu

What does this all mean?

Two kids with smallpox - one vaccinated and one unvaccinated. Can you guess which is which? The vaccinated child on the right only has one or two spots...
Two kids with smallpox – one vaccinated and one unvaccinated. Can you guess which is which? The vaccinated child on the right only has one or two spots…

It means that vaccines work, even when they don’t work as well as we would like them to!

More On the Severity of Breakthrough Infections

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