The Current Whooping Cough Epidemic

Health officials have declared that California is experiencing an epidemic of pertussis, better known as whooping cough. So far this year California alone has experienced 910 confirmed cases and there are 600 potential further cases under investigation. Five infants have died so far, all under the age of three months. Considering how deadly pertussis is to very young children, that number will only increase.

This is not the first time in recent years the state has had a problem with whooping cough. Why California? The answer is simple: California is the center of the American anti-vaccine movement.

The principle behind vaccines is very simple: inject the body with something resembling a virus or other disease-causing microorganism. This allows the body’s immune system to develop antibodies that will “recognize” the actual virus or microbe and will kill it before the body can be infected. Vaccines have been hugely successful; after clean water they are the most successful public health measure in human history.

However, vaccines have always been somewhat controversial and still are today, in spite of modern vaccines being proven to be entirely safe. The modern anti-vaccine movement can be traced to a 1998 paper in The Lancet by the British surgeon (yes, surgeon) Andrew Wakefield linking the MMR vaccine (mumps, measles, and rubella) with autism.

It was later realized that Wakefield’s research was funded by litigants against vaccine manufacturers and that he had not disclosed this conflict of interest; if he had, the paper would not have been published. In 2004, 10 of the 12 co-authors of the paper formally retracted it. In 2009 it became known that Wakefield had manipulated the patient data and misreported results in his paper. In 2010 The Lancet’s editors fully retracted the paper. In May 2010 Wakefield was stripped of his medical license in the UK for ethics violations.

Both the US and UK have spent tens of millions of dollars investigating a possible link between vaccines and autism; they have found none. In the US, the CDC and the National Academy of Sciences (our most prestigious scientific organization) have found no link between the MMR vaccine and autism. In the UK, the National Health Service reached the same conclusion. In February 2009, a special court in the US ruled that the parents of autistic children have no grounds for seeking compensation from vaccine producers.

Jonas Salk was considered a hero; now the inventors of vaccines are sent death threats. There is absolutely zero evidence linking vaccines to autism, yet increasing numbers of American parents are not having their children vaccinated. Why?

The answer is simple: we fear the unknown. And until very recently, the causes of autism were not understood. It is a frightening and challenging condition that causes parents a huge amount of stress and worry. It is not surprising that they are looking for an easy target to blame. However, we now understand some of the genetic risk factors for autism. And as with many conditions, environment (as in, before and during pregnancy) plays a role. Vaccines, very simply, do not.

So why does this matter? For one, children are dying. It is not just whooping cough that is spreading in the US. Many parents justify their refusal to vaccinate their children by arguing that this or that disease is no longer present in the US. However, the reason why it is no longer present is that the population has been vaccinated; the populations of other countries have not been. For example, there was a global effort to eradicate polio, much like smallpox. However, several groups of Muslim imams in Egypt and Pakistan opposed the use of the polio vaccine, meaning the virus is still present in humans. “But that’s not in the United States,” opponents of vaccines argue. This is true, but there is a form of transportation known as the plane. I think you can figure out the rest. And besides smallpox and polio there have been no global efforts to permanently eradicate any diseases.

This is of course completely unfair to the children involved; they do not understand what is going on and are being put at risk. However, the issue is more complicated than that. There are a number of individuals in our society who simply cannot be vaccinated. This can be because of a compromised immune system. Or it can be that they are too young, as the five deaths in California illustrate. There is also an unlikely worst-case scenario: if the virus becomes too widespread, it will inevitably mutate. If it mutates too much, our vaccines will no longer work; you and I will no longer be immune. Fortunately, vaccination rates are still high enough to prevent this.

Unfortunately, there is not much we can do about this issue. Doctors and scientists have been placing study after study in front of the opponents of vaccines to no avail; in the face of scientific denialism it seems that there cannot be any progress. Be prepared for more stories like the California epidemic; diseases we have not seen in a long time in the United States are returning. Though for now, this is not our biggest public health concern. That title probably belongs to either climate change or drug-resistant bacteria. Maybe we should not be talking about cutting the NIH’s budget.

5 Responses to The Current Whooping Cough Epidemic

  1. Kim says:

    Very interesting post. I have a few friends/co-workers that blame the vaccine for their chidlren’s or siblings autism. The timing when the MMR vaccine is given unfortunately coincides with when the signs of autism are often seen in children. They all say their child/sibling was absolutely fine and boom they had the MMR and they became unresponsive to them. No one will ever convince them to vaccinate unless we find out why this epidemic has skyrocketed. I have heard every theory from the MMR causing it, too many vaccines all at once (Which is why those that are vaccinating are slowing down the speed at which it is done), and I have also heard a theory that the children had a genetic factor for the disease and that they had parents that overstimulated them.

  2. C R Krieger says:

    I agree with the points made here, except for two small items.

    1) The statement “modern vaccines being proven to be entirely safe” may be a stretch.  Few things in life are “entirely safe”.

    2) The autism issue is more than its problems.  It is also that it may be on the increase—or we are getting better at identifying it.  Either way, it is a concern to parents.  Over at Wikipedia there is this quote:  “The number of people diagnosed with autism has increased dramatically since the 1980s, partly due to changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved.”  Maybe Kim is correct, it is in the parenting—overstimulation.  As a Grandparent I sure hope that is not the case, or maybe I do hope that is the case, since it points to a solution.

    The thing that is interesting is that it is California with this problem.  Is it all of California or just pockets?

    Regards  —  Cliff

  3. Mike01824 says:

    Nice post. I wonder what the affect of the swine flu will be, since there are charges that it was overhyped. Maybe it was; I haven’t read up on it.

  4. Andrew says:

    First, there is no link between autism and vaccines. I had not heard of the “overload” hypothesis until writing this blog post, but there is absolutely no evidence of it. Here is a fairly comprehensive (and free) discussion of all of the hypotheses:

    I also have never heard of an “overstimulation” hypothesis and, as a biology student, it makes no sense to me. When geneticists talk about environment they are talking about diet, carcinogens in the water supply, that type of thing. Parental style would have no impact on the development of autism. Recently, autism has been linked to a phenomenon known as “copy number variation.” In certain regions of our genome, there are sections that repeat. It has been found that individuals with too few repeats in several loci of the genome tend to have autism and that individuals with too many have schizophrenia. (Specifically, 7 genes on the long arm of chromosome 1, 23 genes on the short arm of chromosome 16, and two regions on the long arm of chromosome 22, accounting for 26 genes.) Please note that these mutations are not the cause of autism; they are merely associated with it. Whether they cause it or not is a question we won’t have answered for a while. There are almost certainly more genes involved, as well as environmental factors such as those I mentioned.

    If speaking with someone who will not have their children vaccinated, it might be worth suggesting that they ask their doctor(s) and nurse(s) if they have had their children vaccinated. I think we all know what the answer will be.

    1) You’re right, “entirely safe” is a bit much, but vaccines are one of the safest health measures you can take. For example, surgery can lead to an infection that will kill you. Or the inappropriate use of antibiotics (not following your doctor’s instructions exactly) can lead to an antibiotic-resistant infection. Vaccines do have side effects (I personally get light-headed after getting my seasonal flu shot), but they are very, very safe.

    2) The scientific community really doesn’t understand why autism is so prevalent now. It certainly has something to do with better diagnostic procedures and more awareness of the condition. Bear in mind also that autism is a spectrum of disorders, and not just one disorder. It could be that people on the lightly-affected end were not being diagnosed. That being said, there are certainly other potential causes; increased carcinogens in our water supply, chemicals in synthetic materials we eat out of, etc. I wouldn’t worry about “over-stimulation” though; children whose parents pay attention to them (but don’t spoil them) do very well in life. (I actually learned the other day that this group of children is the least likely to binge drink, as compared to children whose parents were neglectful or were too authoritarian).

    No, it’s not all of California. The news stories I was reading said that only 2% of the California public school population was not vaccinated. However, in certain towns the percentage ranged from 20 to as high as 70 percent. I interpreted this as representing pockets of anti-vaccine individuals. Perhaps one person became convinced and then convinced their friends.

    Swine flu was remarkably mild for individuals your age; it was rather deadly for individuals who were mine or younger (especially children). It did cause some rather interesting choices to be made. I’ve read stories of pediatricians who had parents come into the office looking for the swine flu vaccine for their child. When the nurse looked at the child’s medical record and saw the child had not been vaccinated for anything else, the nurse would offer the other vaccines. The parent would refuse. This seems to have happened quite frequently. It’s understandable; the risk of death was too high. However, the risk of death from maybe viruses is high. Thus the need for comprehensive vaccinations.

    I’d also like to note that the swine flu vaccine was produced in an identical manner to the regular seasonal flu vaccine; there was nothing special or different about it. The only reason it was not included in the regular vaccine was that it took too long to engineer the vaccine; it wasn’t ready in time. (There have been some breakthroughs recently that would make this irrelevant in the future. It’s possible now, if you have the money, to design a vaccines in a matter of days. We can’t yet mass-produce it synthetically, but that’s coming soon. There’s also a move to switch from growing the flu vaccine in chicken eggs to using a specific type of bacteria. This would be much cheaper, much faster, and cost much less money.)

  5. Dean says:

    What a great country the we can enigeer the swine flu vaccine in such a short period of time. Than get it out to the masses all over the world. Give credit where credit is due. This was never reported in the national press.