Tussle with Pertussis – Whooping cough
Pertussis or whooping cough is caused by the bacterium
Bordetella pertussis. It’s called whooping cough because after a coughing fit, an infected person makes a whooping sound when they try to catch their breath. Babies less than a year old can die from pertussis.
In 2008, about 195,000 children died from pertussis.
http://www.who.int/immunization/topics/pertussis/en/index.html
I want to focus on a ScienceNOW article about new vs. old whooping cough vaccine.
Uptick in Whooping Cough Linked to Subpar Vaccines
Whooping cough, or pertussis, has exploded in the United States in recent years. A new study confirms what scientists have suspected for some time: The return of the disease is caused by the introduction of new, safer vaccines 2 decades ago. Although they have far fewer side effects, the new shots don’t offer long-lived protection the way older vaccines do.
The disease seemed to have disappeared by the 1970s but has come back in the past decade or two. Evidence suggest that the reoccurrence is due to the switch from a vaccine based on the whole-cell bacterium to a new vaccine that has just parts of the bacterium. The newer virus has less side effects but apparently doesn’t offer long term protection. The newer vaccine was developed because the chemicals used to kill the pertussis for the vaccine where causing side effects.
During the 1980s, U.S. parents successfully sued manufacturers, alleging that the whole-cell vaccine also caused long-term brain damage. A 1991 Institute of Medicine report concluded that this was unproven, but by then many pertussis vaccine manufacturers had withdrawn from the market, leading Congress to create a federal vaccine injury compensation program for families who could show a strong case for vaccine damage.
Three studies have shown that the new acellular vaccination, i.e., one based on parts of the bacterium, no the whole cell, is less effective (long lasting) compared to the older vaccine.
Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers in Pediatrics: http://goo.gl/SE6dZ , Number and Order of Whole Cell Pertussis Vaccines in Infancy and Disease Protection in JAMA http://goo.gl/H02wy , Reduced Risk of Pertussis Among Persons Ever Vaccinated With Whole Cell Pertussis Vaccine Compared to Recipients of Acellular Pertussis Vaccines in a Large US Cohort http://goo.gl/TBa4H
So why does the whole-cell based vaccine work better and why switch? The whole-cell based vaccine likely works better because there is more of the cell that is presented to the immune system to generate anti-bodies. Also, as the pertussis bacteria mutate, the new vaccine is likely to have less overlap with the mutated version. The older, whole-cell based version is likely to have antigens that are still effective, i.e., still in the mutated version.
Why is this important? There has been an increase in whooping cough out breaks in the US and measles in the UK. http://goo.gl/8xRa7 via Philip Plait and http://goo.gl/fXzB1
It’s dangerous when misinformation and conspiracy theories affect policy and decision making. If more people are scared into not getting vaccinated, then herd immunity is compromised.
Herd Immunity – One Minute Medical School
http://www.health.harvard.edu/video/herd-immunity/
Using science, we understand that the increase in whooping cough infections is at least partially explained by the switch to the new vaccine, based on parts of the Bordetella pertussis and not the whole cell. It is also partially explained by diminished herd immunity by unvaccinated people/children.
Finally, I’ll point you to as disturbing story about anti-vaxxers going after a family that lost their infant to whooping cough. http://goo.gl/saspV
Image Source: http://goo.gl/D31Fo
#ScienceSunday
May 26, 2013
I think that it is very misleading to leave out the role that pediatricians and big pharma played in the handling of issues regarding the older DPT vaccine. First and foremost, the reactions were very real. Furthermore, the high fevers and loud crying were exactly what the vaccine product inserts warned about. Parents concerns needed to be taken seriouslly. The message was to call your doctor if you sensed any problems. And what was the response of the medical community? In many cases, pretty much what the response of my pediatrician was (in the late 1980’s). I tried to ask him what the dividing line between a “good” (immunity building) fever and a dangerous one was supposed to be. How was I supposed to determine when a reaction was “normal” and when it might be due to other issues such as allergies. He handed me a free sample of Tylenol. I asked him what I was supposed to do with this. He chuckled and said it was “for the parents”. If the parents gave the babe the Tylenol the baby would sleep through the night and not be bothered enough to call the pediatrician. I assumed at the time that this particular pediatrician was a jerk. It was not until my later search for a new pediatrician that I realized that this was apparently common practice at the time. The message was clear: many pediatricians did not want to be bothered. An opening of distrust was created that left room for other messages.
For success with the weaker vaccine all that needs to happen is that people go in for boosters. Here in Washington State in a recent pertussis outbreak the state health department went to great efforts to inform people that the problem was not antivaxxers, it was all of the rest of us, the average adults who needed boosters. Putting these vaccines in easy to access places like local pharmacies has helped. I personally think it is unreasonable to expect parents to opt for the older vaccine when this alternative is available. Since peditricians back in the day seemed unwilling to clearly draw a line, or deal with educating parents on distinctions between “good” and “bad” reactions to the older vaccine back in the day, I personally doubt that they would want to in present times either. And thus medical professionals would seem unlikely to want a return to the older vaccine either.
Similarly, when infants died of whooping cough in California’s Central Valley, the problem was not anti-vaxxers. The issue was the non vaccinated status of immigrant parents. Parents who in many cases had no access to health care facilities themselves. The solution here, and in other states such as Texas, has been “cocoon of safety” programs. Hospitals have begun immunizing parents and other infant caregivers. At the hospital at the time of delivery if necessary.
I think it is time to recognize that antivaxxers are an extremist sideshow. Blaming antivaxxers over emphasizes the easy fingerpointing and skips over the hard work necessary to make all of us more responsible for good outcomes.
Vaccination is a problem that is much better addressed as an overall public health delivery issue.
May 26, 2013
Gaythia Weis your comment about getting a booster is well taken. Until a new vaccine can be made, people who received the new vaccine, likely need a booster. For the California outbreak, the Kaiser Permanente study suggests it was at least partially due to the new vaccine and the need for a boost (see the links above). Last time I looked, the Central Valley outbreak had not been linked to immigrant parents, at least not from reputable sources.
May 26, 2013
/me raises had as an immigrant.
And I vaccinate.
Anyone want to look me in the eye and blame me?
May 26, 2013
Immigrant was used as the politically correct term for possible unofficial legal status. People who may be reluctant to approach our health care system and announce that they had never been immunized. I think that the issue is now quite recognized. Places like Kern County did recognize the problem. At this point the “cocoon of safety” program is statewide. But at the time of the Central Valley infant deaths the idea of immunizing parents and other relatives at the hospital at the time of birth was new. At any rate these families were not “anti vaxxets.
May 26, 2013
Its not about where one come from,vaccines should be effective for the long term development of a child into health adults and into parenthood.
May 26, 2013
So you meant “illegal immigrant”. Well, then perhaps you meant my cousin in law who overstayed her work visa by a couple of years in Colorado in the 90s, working at a ski resort? She was vaccinated too and vaccinates her kids.
May 26, 2013
Gaythia Weis I don’t know you, but your outbreak info about CA is dead wrong.
The outbreak was caused not by illegal immigrants, but by rich white people not immunizing their kids.
May 26, 2013
Vaccines should be working effectively for everybody.For legal and illegal .
May 26, 2013
Gaythia Weis I seriously don’t know where you get your info about the CA outbreak, it is wrong every post you make. I live here, we had a baby during the outbreaks.
The herd immunity was broken not in the Central Valley at all, but in the Napa/Bay Area. The outbreak spread from anti-vaxxer nuts not getting their children the shots. Those yuppie arrogant fools risked the lives of every other infant in CA.
May 26, 2013
Gaythia Weis the pertussis outbreak in CA was not due to any illegal immigrant, according to state officials.
http://goo.gl/XDOS
May 26, 2013
Chad Haney Kimberly Chapman Rugger Ducky The issue is not to blame any particular category, it is to focus on a need for public health access. It may be easy and satisfying to point fingers over there to blame the antivaxxers (or illegals, for that matter). But that is counterproductive. Not only did it give people like Andrew Wakefield years more of free publicity than any one individual nut case deserved, it also took energy away from addressing fundamental public health issues. It subtracts from actually listening to, and addressing the real concerns of real people.
The California whooping cough epidemic of 2010 caused the death of 5 Latino infants in California’s Central Valley. Fresno is not “yuppie arrogant fools” territory.
“Dr. Chavez said that lack of information and inoculations in agricultural regions in the state’s Central Valley — home to many Latino farm workers — might be a culprit in the high incidence in that community. And indeed, Fresno County — in the heart of the valley — has the highest number of cases in the state, with 72 reported in May alone.”
http://www.nytimes.com/2010/06/24/us/24cough.html?_r=0
““The fact that this epidemic is concentrated in the Latino community indicates that lack of accessible medical care — inadequate rates of infants and children being vaccinated —may be playing a role,” observes ACSH’s Dr. Gilbert Ross.”:
http://www.acsh.org/dispatch-an-avoidable-case-of-the-whooping-cough/
In area hospitals a very successful program was instituted focusing on creating a “cocoon of safety: around too young to immunize infants by immunizing parents and other adult caregivers. At the start, this was done by immunizing parents as needed as they showed up for delivery of their child. At the present time, this has been integrated into public health prenatal outreach. By and large, this problem is now being successfully handled.
More recent outbreaks of whooping cough, such as the one in Washington state have been concentrated not in the non immunized but in those whose immunizations have waned. The Washington State health department went out of it’s way to emphasize that the problem is not antivaxxers it is a need for booster shots among those who may be under the false impression that their original vaccine left them protected. Middle schoolers are getting DPT boosters added to the vaccination schedule. Giving everyone ready access to vaccines is considered to be very important. Drug stores now can vaccinate.
Whooping cough epidemics occur in cycles and tend to peak roughly about every three to five years. Before 2010, there was a peak in 2005. It is also true that our abilities to test for the disease has improved. This may increase reports of the disease . But it may also have contributed to helping us realize that there is a problem with the longevity of the current vaccine.
Now that health officials realize that a whooping cough booster is needed, that is the message that needs to get out. To everyone.
May 26, 2013
Except that you did blame a category, Gaythia Weis, and as an immigrant, I’m offended. It’s precisely that sort of scapegoating that leads to massive political policy that punishes immigrants for what has nothing to do with immigrants.
You really need to retract your statement on that score.
May 26, 2013
Gaythia Weis wow, racist and xenophobic much?
Yes, it killed 5 babies in Fresno. Months after it started in Marin County.
May 26, 2013
Obviously, these deaths didn’t occur in the heart of antivaxxer territory of Napa or Marin.
Kimberly Chapman I certainly do want to retract my statement to the extent that it makes you feel offended as if it applies to all immigrants. I do not wish to engage in scapegoating. If you have suggestions as to better ways of how specific demographic catagories that need addressing can be discussed without creating these difficulites I am open to learning about them. As the Los Angeles Times article that Chad Haney quotes says this has nothing to do with illegal aliens in general. There are plenty of people in Los Angeles with illegal status and this is not where the deaths occurred. As that article states, most people in Mexico do get immunizations and most people of Mexican decent in the US do also. I assume that Los Angeles has done a much better job at public health delivery than has much of the Central Valley. But still, there really are people who have arrived into this country from some of the poorest regions of Mexico or Central America to work as migrant laborers in our fields or elsewhere. Lack of medical access or monitoring can be a serious issue. Much of this makes life much more dangerous for these people themselves not others. Exposures to chemicals and pesticides for example. I don’t want to be among those who sweep these issues under the rug as if they do not exist either.
May 26, 2013
Talking out your ass like you know things you don’t, blaming the wrong people for starting these epidemics, and generally proving yourself a xenophobic racist.
Yes, let’s just blame all the brown people here. It HAS to be their fault.
May 26, 2013
Since we are doing the pick and choose quote game…
Last October, the National Committee for Quality Assurance issued a report finding that vaccination rates among privately insured two-year-olds declined by nearly 4 percent in 2009—even as rates among enrollees in Medicaid, the government-run insurance program for low-income families, increased. In fact, 91.2 percent of children in Medicaid received the measles-mumps-rubella vaccination, compared with 90.6 percent of children in private plans. In California’s wealthy Marin County, public health official Fred Schwartz reports that parents are “signing waivers to opt out of immunizing kindergarten-bound children.” About 7 percent of all children entering kindergarten in Marin County are unvaccinated, the seventh-highest percentage among California’s 58 counties. It isn’t surprising, then, that Marin County accounts for 15 percent of all California whooping-cough cases, despite having just 0.67 percent of the state’s population.
http://online.wsj.com/article/SB10001424052748704858404576134141248186466.html
May 27, 2013
Kimberly Chapman she didn’t mean white immigrants like you.
May 27, 2013
I just looked up the following;
http://www.cdph.ca.gov/programs/immunize/Documents/PertussisReport2013-05-01.pdf
New in this report:
No pertussis deaths have been reported in California since October
of 2010 and now appear to be at historic lows
In 2010: Ten deaths were reported; 9 (90%) were Hispanic infants.
In order to prevent the next pertussis outbreak cycle, the largest reservoirs of non immunized people need to be addressed. By far, these are composed of adults, mostly those who were vaccinated long ago but now no longer immune, and those that were never immunized. Both of these groups have no objection to immunization, they simply need to be made aware of the problem and to have immunization opportunities provided to them.
In my opinion, one of the questions Chad Haney ought to be asking above is why (if true) did it take the threat of a lawsuit to get the pharmacuetical industry working on an improved vaccine. Because high fever, screaming cries and in some cases convulsions are obviously very concerning. Many of us chose this option with the knowledge that it was the better alternative to the disease, but this did not mean we were happy about it.
And the next question ought to have been why was it that adequate followup studies on the newer vaccine were not done to see that immunity was lessening BEFORE another outbreak took place.
And finally, why is it true that despite outbreaks in places such as here in Washington State, there is no national program to ensure that adults even know that they need to get boosters for pertussis?
(Rugger Ducky those on Medicaid are obviously not among those lacking access to medical care in our society. )
May 27, 2013
Gaythia Weis please, do tell me, without googling for it, what the rate of unvaccinated children of undocumented immigrants in CA? I know what it is, and it is higher than the vaccination rate in Marin County in 2009. CA has some amazing vaccination programs specifically for the children of undocumented aliens.
Most of the deaths were in Hispanic infants, not specifically undocumented families. Do you even know that California used to be part of Mexico? Your assumption that because the deaths were predominately in Hispanic families that they must be illegal immigrants continues to underscore a serious racist and xenophobic disconnect in your brain.
Poor kids died, because rich white parents who could afford the medical bills didn’t get their kids immunized. Because autism. Yeah.
May 27, 2013
The poor kids that died in the Central Valley were most assuredly not associating in any way with the antivaxx children in Marin County.
California does have excellent immunization programs for children. And these were too young to immunize infants. The missing components in the immunization program at that point in time were the parents and other adult caregivers. The “cocoon of safety” program was effective in getting public health to focus efforts on these adults.
May 27, 2013
Oh. Yeah, no way migrant farm workers could have gone up to Marin to harvest any crops, bringing disease back to their Central Valley homes. There aren’t any crops in Marin worth harvesting. Just some grapes.
Where the fuck, seriously, the fuck do you come off? Do you have any idea how close the Central Valley is to Marin? Have you ever even looked at a fucking map in your life?
Keep digging that hole. The herd immunity was broken in Marin by rich white families, and it wreaked havoc on kids all over after.
This isn’t about not taking care of the poor. You’d be very surprised at the things I personally do to increase access to medical care around the world. But it isn’t my job to brag about what I’m doing to make the world better here: on G+ its my job to call bullshit when I see it.
May 27, 2013
It’s not just about offending me personally, Gaythia Weis, and I’m not asking anyone to sweep anything under a rug. This is indeed a wide public health issue and absolutely there is a problem that some socioeconomic groups are unduly burdened with costs and insufficient information about vaccinations relative to wealthier ones who are ignorant more by choice than circumstance.
But you need to understand that this blame-the-immigrants meme is a REAL PROBLEM and one that gets used to marginalize and set actual policy. The very notion of Mexicans bringing in diseases and not being good parents and/or not practicing good health care was embedded throughout the nonsense in Arizona’s rhetoric leading to their oppressive laws. The specific issue of denying health care to illegal immigrants is used to cut them in all ways: they’re to blame for not getting care, they’re dirty and filthy and unclean for not getting care, so let’s keep them out of our community by not letting them have care.
For you – someone I otherwise respect on STEM issues – to include immigrants as a group to blame for vaccination issues, especially wrongfully, is profoundly disturbing. It’s not me you need to apologize to. It’s the entire community of immigrants whom you have just helped legitimize a campaign of terror and oppression upon. You just spouted the same things that those who seek to enslave that population says.
I’m white. I’m Canadian. I’m affluent. I’m a legal immigrant (and actually now a US citizen as well). But by all that’s decent I will stand arm in arm in solidarity with the most egregious illegal immigrant when it comes to American predilection for pulling the word IMMIGRANT out to blame for public health issues, economic issues, or any other issue that needs a dog to kick.
Because if I was Latina and had said I was raising my hand as an immigrant who vaccinates, I’m betting you wouldn’t have kept trying to define why my people have any culpability in this whatsoever.
And this is not the first time I’ve had this conversation with white Americans. In fact, it’s so distressingly common that I was able to predict precisely how this would play out, and I was right.
Further: I know anti-vaxers. I know MANY of them. And while their reasons vary widely, they are all affluent, white, educated, and people who have little excuse not to know better but for one reason or another have chosen to remain ignorant or chosen to believe the anti-vaxer side. Dozens and dozens of mothers in my Austin Mama circles wave their willful ignorance about like a banner of pride. Almost none of them are immigrants, and the two I can think of who are are Canadian and British…and also very affluent, here legally.
Don’t you dare shift the blame from the privileged to the underclass. Don’t you dare. This isn’t about PCism: this is about actual facts and human rights.
May 27, 2013
Kimberly Chapman I am in complete agreement with your statement above. So I obviously need to go back to my previous statements to see where my statements have gone astray. Because I don’t want to contribute to actions that continue to blame the victims.
As I see it, focusing on antivaxxers is a way of focusing on the problems of privilege and not on real problems of public health delivery. I don’t blame the Hispanic families of the children that died. Changes in public health care policies are now helping to get more of these families immunized, and that is as it should be. I think this exemplifies why we should not be distracted by a few antivaxxers over in Marin county or such places and duck our responsibility to support and fund health care programs.
Other vaccination programs have these same sorts of problems. We focus on HPV vaccines for 12 year olds, but not Pap smears for poor women. We immunize infants for Hepatitis B, but nearly all infants with Hep B are born that way, from Hep B infected mothers.
And, finally, in most egalitarian fashion, in the case of Whooping Cough it is practically everybody that now needs a booster shot if they haven’t done so already.
Funding such programs is an ongoing responsibility that we all ought to embrace. Blaming anti-vaxxers doesn’t get us there.
May 27, 2013
Oh I’m in total agreement for complete healthcare overhaul, Gaythia Weis. But I’m also trying to adopt an infant and because so many of the Austin area moms are anti-vaxers, I have had to be very clear that I cannot associate with them with an infant without risking that infant’s life. I used to be tolerant of other people’s choices but then I learned about herd immunity and it’s not okay that my baby could die because of other people’s mistaken philosophy.
And anti-vax is so prevalent here that I may actually have trouble socializing with an infant safely.
Those other health care problems are problems, but none of that alleviates the culpability of anti-vaxers.
May 27, 2013
I will have to respond in detail tomorrow. The power went out on my block. Anti-vaxxers are often anti-science or believers in big pharma conspiracies, both of which cause people to make poor choices.
May 27, 2013
Thanks, Chad Haney This is good information.
May 27, 2013
Kimberly Chapman I agree with those parents of young infants who are now taking much greater care as to who their young infants meet. With current knowledge, much greater restrictions on encounters between those infants and others that may not be vaccinated is warranted. And not just with regards to immunization. Babies naturally explore things with their mouths, but that never meant I wanted someone else allowing my baby to suck on their fingertip. Which seemed to be a prevelent compulsion.
But in addition to your antivaxxer friends, I think you need to consider that any teen or adult may no longer be immune and may pose risks of whooping cough. And some of those people may even be close relatives. Maybe instead of traditional baby showers we should throw pre-baby immunization and booster shot parties.
May 27, 2013
When the Duckling was born (quite close to Marin, I might add), we required everyone coming to visit for more than a few minutes to get a booster. We even went so far as to setup appointments ahead of visitors at the local CVS for their vaccines. And it wasn’t just pertussis, but mumps, measles, and rubella as well. All the preventable diseases that will kill an infant through the callous actions of those who refuse to vaccinate themselves or their older children.
As for kids putting things, even other people’s fingers in their mouths, if you’re worried about it, ask people to wash their hands before they handle your kid. Its a no brainer.
May 27, 2013
Gaythia Weis if you want to help poor women get pap smears, donate or volunteer at Planned Parenthood.
May 27, 2013
Gaythia Weis I’m well aware of that. I don’t have anti-vaxer friends anymore. I have anti-vaxer acquaintances. Pretty much in recent years if someone is a die-hard anti-vaxer, we’re not friends because they’re too anti-science and irrational to be around. I tried with some but hooboy the ignorance was too painful after awhile.
We’ve been saying since last fall that anyone who wants to be around the new baby when he/she comes needs to have their boosters. Thankfully some of the older cake ladies I’d otherwise have trouble convincing to bother also have been regularly driving past one of the big billboards in town pushing boosters for older folks for precisely this reason, and a few have had grandbabies and gotten proper lectures from their own medical types, so they’ve been going out and getting their shots. Bravo for combined public-private wins.
May 27, 2013
One of the reasons I favored the (then new) baby “snugglie” or backpack carriers over traditional strollers was that it was easier to fend off interested passers by.
I assume, Rugger Ducky that you realize that stopping off for a vaccination on the way to a visit does not yield the required lead time for immunity building results?
Of course I actively support Planned Parenthood. That does not preclude also supporting other public health efforts.
May 27, 2013
Gaythia Weis yes, as a matter of fact, we do know a month is the best possible lead time. The only people allowed to get the boosters less than a month before were three of the grandparents, who have minimal contact with any other kids, and were in the Seattle area before the outbreak spread there. Everyone around here was sent to CVS before the Duckling came.
And yes, we can and should blame the antivaxxers for their complicity in the deaths of these innocent infants.
The comment about pap smears was in direct response to yet another ignorant comment out of you: We focus on HPV vaccines for 12 year olds, but not Pap smears for poor women.
Planned Parenthood is focused on this type of care. They aren’t, contrary to right-wing scream campaigns, focused on abortion. They are primarily there for female reproductive health services.
Additionally, in CA, and several other states, proof of citizenship, or even ID is not required to seek care at PP.
May 27, 2013
Oh yeah, I should mention we are from Seattle, and also a lot more aware of the WA outbreak than you think. I’ve let all your inane comments about cause there go, because I’ve been way more offended by your racist and xenophobic comments about immigrants.
May 27, 2013
There has been considerable publicity in Washington State regarding the need for boosters by everyone, and fears on the part of local health departments that a false focus on antivaxxers would lead to complacency on the part of the public in general.
“As the cases pile up, they have allowed epidemiologists to see the big picture: The major spikes in cases are occurring in younger teens, up to about age 15, who have never gotten the whole-cell vaccine (the DTP or DTwP) and have received only the acellular vaccine, the DTaP and Tdap.”
http://seattletimes.com/html/localnews/2019300548_whoopingcough30m.html
Kimberly Chapman is correct that we need to tread very carefully in discussion of demographic trends in disease distributions not to trigger racist and xenophobic responses. But it is also true that focusing on the problems of the wealthy (as in Marin County) at the expense of the poor and politically unrepresented also is a racist and class privileged response.
As another example where such a carefully devised strategy is necessary: Hepatitis B is a disease that disproportionately impacts those with Pacific Islander origins and there are programs aimed specifically at this community: http://www.cdc.gov/Features/ChronicHepatitisB/
Attempting to tread very carefully: It is a given that the Hispanic communities of California are very large and very varied. The bulk of the reported cases of whooping cough are among non Hispanics. Still, it is true that the statistics for the whooping cough outbreak of 2010 as reported by the California Department of Public Health are as follows:
http://www.cdph.ca.gov/programs/immunize/Documents/Pertussis%20report%209-14-2010%20-%20For%20Release.pdf
“113(77%) of the hospitalized infants <6 months of age were Hispanic"
And as I noted above, 9 of the 10 deaths were Hispanic infants.
But it is also true that:
“Overall rates by race/ethnicity are highest in whites (9.8/100,000), however age-specific rates indicate that the highest rates are seen in Hispanic infants <6 months of age (229/100,000)"
This was a reason (back in 2010) for the California Public Health system to focus on an evaluation of public health delivery systems in California’s Central Valley. I believe that the spotlight on these counties has caused them to now be doing a much better job at servicing this population. The Los Angeles Times article quoted by Chad Haney quite rightly emphasizes that this is not a reason to negatively stigmatize all illegal immigrants. Most areas of California do serve their entire populations in fairly effective fashion. And Kimberly Chapman quite rightly express the concern that a viscous cycle can be set up in which fear of minorities sets up repressive measures that further limit minority access to public services and leads to further problems for general health and public safety for all as well as those most directly impacted by the repression.
May 27, 2013
Gaythia Weis wow. There is nothing like a closet racist to keep on trying to dig their hole deeper.
So I take it that aside from being white, you’re the typical narcissistic white northwesterner, thinking that because you’re liberal and in favor of caring for the poor and people of color that you aren’t racist. Except that it is your very arrogance and looking down your nose at others that makes it clear.
Don’t feel bad, I’ve been there myself. I grew up a liberal wetsider, even raised by a mom who did voters registration for the SNCC in the 60s.
At 17 in Basic Training, I was hurt, confused, and mind-boggled when a black woman assumed I was racist, because I stuck up for a white woman in the platoon. The black woman had snatched the letters to the white woman’s bf she was writing. A huge platoon wide drama ensued, until the very awesome DS called us all together and blew that shit out of the water. She told us to first off just try and forget what we think we know from past experiences–that this was the Army, where we all wear green and bleed red.
That’s when I realized I was racist. Not because I assumed there were any negatives to being a person of color, but because I realized until that moment I had always still seen women of color as different. As not quite the same as me. How much melanin is in your skin, where your parents came from, it doesn’t matter. What matters is that we all choose to be here in this great experiment of a country.
May 27, 2013
I certainly am not claiming to be not racist. What I said above, in response to real objections is that I was “attempting to tread carefully” in recognition that my previous statements clearly sounded xenophobic to some. We live embedded in a racist society. As such we need to make best effort attempts at ensuring that such things as public health resources are appropriately provided and that what resources are provided not diverted from the poor towards the wealthy and powerful.
At any rate, the current issue with whooping cough is quite egalitarian.
I think it will be interesting to see what further posts Chad Haney will have on this subject. There seems to be considerable interest on the part of the CDC for the development of a new, improved vaccine that can deliver the immunity of the original without the more severe side effects. I hope that translates into research funding.
May 28, 2013
In 2010 the highest rates of pertussis were in Marin and San Luis Obispo, supporting Rugger’s claims.
http://goo.gl/A31Bt
I think the quote from Ken August, a spokesman for the California Department of Public Health, in the LA Times article I mentioned carries more weight than the American Council on Science and Health. The fact that nine of the 10 infant deaths in 2010 were Hispanic does not mean it was due to under vaccinated Hispanic parents. We can even speculate that those babies were exposed to pertussis by affluent anti-vaxxers. However you claim the poor kids that died in the Central Valley were most assuredly not associating in any way with the antivaxx children in Marin County.
Again, I agree that booster shots will help a lot. I also agree that the healthcare system needs a lot of improvement. What we disagree on is the influence of anti-vaxxers and believers in big pharma conspiracies. One of the purposes of this posts was to point out how science works, i.e., there was a hypothesis that the new acellular vaccine was having an effect on some of the pertussis outbreaks. The publications I linked above came to the conclusion that the acellular vaccine does not last as long as the old vaccine, based on the whole cell. Another purpose of this post was to point out that vaccines work, science works, and we can continue to learn. I do my best to present facts that are supported by peer reviewed publications and not allow anti-vaxxers to spread FUD.
May 28, 2013
Chad Haney Worth reading, IMHO:
http://www.risksense.org/2011/01/23/public-health-needs-humility-to-address-vaccination-fears/ This has to do with effective vaccine science communication to the public at large.
The key public health metric for whooping cough is prevention of infection of too young to immunize infants, because that is where the greatest health risks occur. The number of older persons diagnosed with whooping cough is very dependent on whether or not coughs are recognized as such.
We need to get big pharma in gear:
http://www.cdc.gov/vaccines/vac-gen/shortages/default.htm#pentacel
_”DTaP Vaccine Supplies Will Be Limited for Summer 2013 Although No Change in Immunization Recommendations, CDC Offers Guidance During Shortage”_
May 28, 2013
Gaythia Weis worth reading, IMHO.
Doubt and Denialism: Vaccine Myths Persist in the Face of Science
http://goo.gl/f7Y1f written by Liza Gross
I’m getting annoyed. You dug yourself a hole. I have actual work to do and it’s late. I don’t have time to waste responding to you.
May 28, 2013
One last try: Center for Disease Control: Pinkbook: Immunization Strategies for Healthcare Practices and Providers. May 2012
http://www.cdc.gov/vaccines/pubs/pinkbook/index.html
[should be: http://www.cdc.gov/vaccines/pubs/pinkbook/strat.html]
“One key to a successful strategy to increase immunization is matching the proposed solution to the current problem. At present in the United States, most persons have sufficient interest in and access to health care and are seen, at least periodically, in healthcare systems. Those who remain unvaccinated are so largely because healthcare practices and providers do not always optimally perform the activities associated with delivering vaccines and keeping patients up-to-date with their immunization schedules.“
As this report notes, we’ve shifted from a system in which public health departments delivered immunizations to one that is largely dependent on private health care providers.
This report also notes:
“Economic and racial disparities exist. Low-income and minority children and adults are at greater risk for underimmunization.”
We need to focus on providing public health access.
And getting our health care providers to serve as appropriate role models, since most discouragingly:
“Rates of influenza immunization are also unacceptably low among healthcare providers, an important target population for vaccination. Typically, fewer than 60% of healthcare providers receive influenza vaccine.”
Jousting with antivaxxers is a sideshow.
May 28, 2013
Jousting with antivaxxer sympathizers is annoying.
May 28, 2013
I am strongly pro-vaccine. In my opinion, addressing our current whooping cough problems as well as those of other diseases for which vaccination is a solution would be best met by:
1 A US based pharmaceutical system that is willing and able to provide vaccines to meet demands.
2. Research support for new and effective vaccines that is driven by disease need, not marketing concerns.
3. Restoration of a public health system that gives easy access to vaccine clinics.
4. Putting more focus on the need for adult immunizations, especially in the current crisis with the fading of the immunity to whooping cough.
5. Getting our public health providers on board and serving as vaccine supporting role models by vastly increasing their flu vaccination rates.
If we want to marginalize anti-vaccine extremists as the isolated anti-science nut cases that they in fact are, we need to stop providing them with a stage. We need to focus on the general public and insure that we provide mechanisms for addressing real public concerns. Obstetricians have learned to provide prenatal classes that address many folk myth issues. In my opinion, the hand-off to pediatricians at the birth of especially a first child is too abrupt. We’ve lost key relationships that existed with a more stable society and long term family doctors. We need to work on mechanisms that build doctor/parent trust.
September 5, 2013
Parents that prevent their children from receiving vaccinations are a public health risk. They not only risk the lives of their own children, but everyone else’s children. There is not amendment to the US Constitution which protects the non-existent right to make others sick and possibly die. Take the children away from such idiots.
September 5, 2013
Craig Olesen we need to educate people about herd immunity and keep fighting the misinformation from anti-vaxxers.