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Pertussis: know the vaccine, the epidemic and your rights

Like most parents who received the vaccine alert this spring, I thought my child would be ousted from school without the whooping cough (pertussis) vaccine or “Tdap” booster. The letter, like many others across California, did not explain that parents have a choice in this matter. California is one of 20 states that allow vaccine exemptions for personal beliefs as well as medical and religious beliefs. For this particular exemption, California requires a signed, blue exemption form available only at the school office. There is intense pressure from parents, schools, and the medical community to dutifully follow immunization recommendations without question. This is a tragically missed opportunity to help people make educated choices based on individual concerns, conditions, and risks.

There are many unanswered questions about pertussis and the vaccine that deserve attention before inoculation. The incidence of pertussis is cyclical, with summer or fall peaks occurring every 3-5 years in the United States. Vaccinations for pertussis have been widespread since the 1960s, with children getting repeat doses between two months and six years of age. Vaccination rates remain high in California, yet the number of pertussis cases last year rivals numbers from 1947. This begs the first question – why are the current vaccines not protecting us?

The pertussis problem escalated into an epidemic after infant deaths mounted last year. Nine of the ten deaths were infants less than 2 months of age. According to an LA Times investigative report, many of these infants were not diagnosed or treated with pertussis which contributed to their deaths. Even after diagnosis, a couple of the hospitals did not react fast enough. While it is easy to point the finger at adolescents who aren’t recently vaccinated, the hospitals appear to lack sufficient diagnostics and treatment to prevent mortalities. A survey of San Diego County adults found that 42% of healthcare workers were not covered by Tdap. Both adolescents and adults can be infected with pertussis without any symptoms.

Even if we vaccinated entire adult and adolescent populations to wage war on pertussis, there is growing evidence that our vaccine may not be effective. The pertussis vaccination is approved based on inferences between different age groups with short-term testing periods rather than direct experience over decades. A nonprofit company in San Diego that analyzed 2010 CDC data found that 53% of California children 8 to 10 years old who were diagnosed with pertussis were up to date with vaccinations. Research in the Netherlands points to new, different strains of the bacteria that appear to have adapted to vaccination through gene regulation. Another suspect is the Tdap itself, with a safer, lowered concentration of the toxoid introduced in 2005 for adults and adolescents. In the mid-1990s, the acellular vaccine DTaP had replaced the original potent DTP after it was associated with possibility of brain damage. It is not clear how these changes in the vaccine have affected the prevalence of disease or long-term health effects.

It is unfortunate that one of the major supporters of Assembly Bill 354 (2010) was GlaxoSmithKline, one of the Tdap manufacturers.(21) Was this commercial thrust necessary? Major studies that influence our immunizations are also driven by institutions and researchers who receive grants from vaccine manufacturers. These corporate ties are an obscured conflict of interest that creates an unsettling foundation for the future of public health.

Unlike food nutrition labels, we are not well-informed about vaccine ingredients. The Tdap vaccine contains chemically inactivated pertussis toxin, but other components differ between the two manufacturers. GlaxoSmithKline makes BOOSTRIX which includes formaldehyde and polysorbate 80. Sanofi Pasteur makes ADACEL which includes formaldehyde, aluminum phosphate, glutaraldehyde, and 2-phenoxyethanol. The toxin in the BOOSTRIX vaccine was grown in a medium containing bovine (cow) extract or casein. Parts of the syringes contain latex rubber. Scientists do not know how these components interact with our immune systems to affect our long-term health. Contrary to some media reports, we do not have any conclusive evidence that proves or disproves a link between vaccines, autism, and other autoimmune diseases.

We all know that vaccines have saved countless lives. They are the weapon of choice at this point in modern medicine. But we cannot assume that every vaccine is equally effective for prevention or equally safe for long term health. Before we take a shot in the dark, let us consider the pertussis epidemic as a call to action for new methods and solutions that promote our individual health, safety, and freedom.

-Shari Cheves

1. California Assembly Bill AB354 (2010) – Bill Text. Official California Legislative Information. 29 September 2010. 14 May 2011 <>.

2. Torlakson, Tom and Mark B Horton, MD, MSPH. “Pertussis Immunization Requirements – Letters (CA Dept of Education).” 1 February 2011. California Department of Education. 14 May 2011 <>.

3. California Department of Public Health. “Pertussis Report – March 9, 2011.” California Department of Public Health – Immunization Branch. 9 March 2011. 14 May 2011 <>.

4. De Greef SC et. al. Seasonal patterns in time series of pertussis. Epidemiol Infect 2009; 137(10): 1388-95. PubMed

5. Lin YC et. al. Epidemiological shift in the prevalence of pertussis in Taiwan: implications for pertussis vaccination. J Med Microbiol 2007; 56(Pt 4): 533-7. PubMed | Full text

6. Sonnenberg A. Seasonal variation of enteric infections and inflammatory bowel disease. Inflammatory Bowel Diseases 2008; 14.7: 955-959. PubMed | Full text

7. Lin II, Rong-Gong. “Diagnoses lagged in baby deaths.” Los Angeles Times online 7 September 2010. 13 May 2011 <>.

8. Centers for Disease Control and Prevention. “Pertussis — United States, 2001–2003.” 23 December 2005. 14 May 2011 <>.

9. United States African-American Population. Map. Census 2000 analyzed by the Social Science Data Analysis Network. 14 May 2011. <>.

10. United States Hispanic Population. Map. Census 2000 analyzed by the Social Science Data Analysis Network. 14 May 2011. <>.

11. Schellekens, Joop MD, PhD et al. Pertussis Sources of Infection and Routes of Transmission in the Vaccination Era. The Pediatric Infectious Disease Journal 2005; 24.5: S19-S-24. Full text | PubMed


12. Miller, Brady L et al. “Barriers to early uptake of tetanus, diphtheria and acellular pertussis vaccine (Tdap) among adults—United States, 2005–2007.” Vaccine 2011; 29.22: 3850-3856. PubMed

13. Sawyer, M et. al. “Tdap Coverage Rates During a Major Pertussis Outbreak: Results From a Cross-Sectional Survey of Adults In San Diego County.” 45th National Immunization Conference. 29 March 2011. 15 May 2011 <>

14. Skibinski D, Baudner B, Singh M, O’Hagan DT. “Combination vaccines.” Journal of Global Infectious Diseases 2011; 3.1: 63-72. Full text

15. “Institute for Vaccine Safety – Tdap Vaccine Components.” Institute for Vaccine Safety – Johns Hopkins Bloomberg School of Public Health. 16 February 2011. 14 May 2011 <>.

16. Morrow M et al. “Unique Th1/Th2 Phenotypes Induced During Priming and Memory Phases Using IL-12 or IL-28B Vaccine Adjuvants in rhesus macaques.” Clin. Vaccine Immunol. 2010; 17:10: 1071-412X/10. Full text | PubMed

17. Centers for Disease Control and Prevention. “Recommendations of the Advisory Committee on Immunization Practices (ACIP).” 28 January 2011. 14 May 2011 <>

18. Centers for Disease Control and Prevention. “Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccines – Recommendations of the Advisory Committee on Immunization Practices (ACIP).” 24 March 2006. 14 May 2011 <>.

19. Crowe, Kevin, Brooke Williams, and Joanne Faryon. “Experts Zero in on Waning Immunity in Whooping Cough Epidemic.” Watchdog Institute online 28 March 2011. 14 May 2011 <>.

20. Bart MJ et al. Comparative genomics of prevaccination and modern Bordetella pertussis strains. BMC Genomics 2010; 1:627. Full text | PubMed

21. California Assembly Bill AB354 (2010) – Bill Analysis. Official California Legislative Information. 17 August 2010. 14 May 2011 <>.

22. Vaccine Adverse Event Reporting System <>

23. Lin Y, Slight S, Khader S. Th17 cytokines and Vaccine Induced Immunity. Semin Immunopathol. 2010; 32(1): 79-90. Full text | PubMed

24. Cookie A. Th17 Cells in Inflammatory Conditions. Rev Diabet Stud. 2006; 3(2): 72-75. Full text | PubMed

25. McIntosh, Anne M et al. Effects of vaccination on onset and outcome of Dravet syndrome: a retrospective study. The Lancet Neurology 2010; 9.6: 592-598. Full textPubMed

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