Diphtheria, Pertussis, and Tetanus (DPT) Vaccine

Archived Q&A and Reviews

Whooping Cough (Pertussis) Epidemic in California

March 2011

(This letter was published in the March 3, 2011 BPN Announcements newsletter)

Dear Parents,

BPN continues to receive postings that make us worried that parents out there do not understand what is happening right now with whooping cough. This bacterial disease, which peaks in late summer, is extremely contagious, and can last for months, with coughing that is severe enough to crack ribs and break blood vessels and require hospitalization. It mainly strikes babies and young children, who catch it from unvaccinated teens and adults. The DTaP vaccination protects against whooping cough, but babies must have 3 shots between 2 and 6 months. A total of five doses are needed by kindergarten, and a booster at age 11. In California, we are having a whooping cough epidemic, and the state Dept of Public Health is now recommending that adults be vaccinated too if they are health care workers, or work with babies, or are women of childbearing age, including pregnant women.

I have spent some time researching this and I want to give everyone some basic current information that I got from the Ca. Dept of Public Health: http://www.cdph.ca.gov/HealthInfo/discond/Pages/Pertussis.aspx

  • In 2010, California had 8,627 cases of whooping cough, the highest since 1947, and far higher than previous years. Example: under 1000 cases 1970-2000.
  • There were 10 deaths from whooping cough in California last year. All of these were babies 0-2 months, too young to be vaccinated fully.
  • In Berkeley there were 18 cases of whooping cough last year.
  • There were 422 cases in Alameda County, 217 in Contra Costa County.
  • Marin County had 345 cases, one of the highest rates in the state.
  • Marin County also has the highest rate of parents opting out of vaccinations via a Parental Belief Exemption
  • The CDC recommends a 90% immunization rate to protect the entire community.
  • In some private schools in Berkeley and Oakland, the rate of vaccination is only 50% to 60%. (BUSD and OUSD rates vary from 60% to 100%)
  • The worst rate is at a Montessori school often recommended on BPN, where only 23% of kindergarteners are vaccinated.
You can actually look up vaccination rates online for all California schools with 10 or more kindergarteners: http://www.cdph.ca.gov/programs/immunize/Documents/2010IZRateTable.pdf
Oct 2006

I've been seeing a lot of press lately on whooping cough and strong suggestions for any adults who have regular interactions with newborns (parents, nannies, grandparents, etc.) to get vaccinated for it (see article link below that appeared on the front page of the SF Chronicle 9/15).

Have others been hearing about this from their pediatricians/OBs? Is this hoopla or is there merit to this? Where does one get these vaccinations in the East Bay (my OB said they do not offer them at her office)? We are expecting our first child in November so want to take the right precautions. And on a similar note, is it recommended that folks interacting with newborns get flu vaccines as well? http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/09/15/MNGJFL6BU81.DTL=whooping+cough=001=10 00 Many thanks for any advice. Katie

Hi, My husband and I both got whooping cough while living in San Francisco in 1998. I never saw my doctor about it and his doctor didn't believe him until his test came back positive. We were pretty surprised, too, thinking of this as one of those ''old fashioned'' diseases that was more or less wiped out decades ago. But believe me - there is no mistaking whooping cough. It is MUCH worse than just a bad cough. As a healthy adult it is not likely to cause serious complications, though it puts you out of commission for a while and then you continue to have serious, rib-cracking nightime coughing for months and months. Having had it, I have no trouble at all seeing how it could harm or kill someone in more fragile health. It turns out that cases of whooping cough have been on the rise in the last few years. We were both vaccinated as infants, but the vaccine wears off after a number of years. I'm not posting this to tell you to get the vaccine. If I hadn't recently ''reupped'' my immunity, I don't know whether I would have gotten vaccinated before my child was born. The risk of getting the disease is almost certainly very low. I just want to to put it out there that people in the community really are getting whooping cough and that it is a truly serious illness. Good luck, done coughing
I saw that article too and my husband and I both got the booster as a precaution (we have a baby in the house). The nurse that gave me the shot went on and on about how good it was we were getting the booster because there is an adult whooping cough outburst going on right now. The article I read recommended that pregnant women get the shot as soon as they give birth and, as you said, all others who live in the house or care for the baby get the booster as well. Babies typically get his/her first whooping cough immunization at 2 months, so I think it's just those first few months that are of the most concern for the baby. As for how we got the shots, we just asked our general practitioner. It's a combined booster with tetnus and so it's really common. good luck!
Yes, whopping cough has been coming back. Because of this, they now add whopping cough vaccine (pertussis) to the tetanus shot that adults should get every ten years. My last tetanus shot was in 2001 so I wouldn't be due for another one until 2011. I have a two year-old and I want another baby next year so I went to my doctor's vaccine clinic (kaiser) and asked for a tetanus with pertussis and got one. Just go get a tetanus shot (and make sure it contains whopping cough.) You can ask your doctor where to get one Andi
My whole family got whooping cough in 1998 when we were living in San Francisco too. The kids recovered after about 1 month, but my husband and I were sick for weeks. The first 3 weeks I coughed around the clock and lost my voice. I had damage to my laryngeal nerves. I had to go to speech therapy and missed weeks of work. The cough was so severe all of us coughed up our food. My husband and I lost a lot of weight and never felt so unhealthy in all our lives. I had severe coughing relapses for several years but I am finally better. My voice is softer and I can no longer sing because my voice cracks. I got a whip-lash injury to my neck from the forceful coughing and I still have neck pain which is permanent. Judy
Feb 1999

Please contact your peditrician ASAP to make sure your baby was not given the low dosage discussed. I was surprised to find out that my baby was given this lot# of the DTP vaccine and I am now waiting to find out from my doctor what the next step will be for her vaccine series.

Problem Vaccine Lot Recalled

The Food and Drug Administration is recalling one lot of Tripedia, the diphtheria, pertussis, and tetanus (DPT) vaccine, because it may not be potent enough. Experts say the diphtheria portion may not be effective in preventing the disease, reports Reuters (1/29). Children who received a vaccine from the lot, distributed between February and June 1998 and bearing the numbers 0916490, should receive a supplemental dose. Doctors give children the DPT vaccine at two months, four months, and six months of age, and booster shots between 12 and 18 months of age and before entering kindergarten. For more information, contact your child's pediatrician.

Related Topics: Immunizations ( http://www.babycenter.com/refcap/95.html )
Debate Over Vaccines Rages(http://www.babycenter.com/news/19971222.html#2458 )
More Proof Vaccines Are Working( http://www.babycenter.com/news/19971006.html#1936 )
No-Needle Vaccines On the Way?( http://www.babycenter.com/news/19980302.html#2888 )
July 1998

I am concerned about the DPT vaccination. Doesn't our baby receive protection from breastfeeding, and from natural exposures in the environment? Luigi

I have to echo that pertussis is such a horrible thing to watch your child go through. My son was exposed to it at 1 month old. We stayed over a week at the Oakland Children's hospital. It was only by God's mercy that we got through the whole thing and the baby is now fine and healthy. I would DREAD the idea of him getting it at 4 month when he was at daycare and passing it on to other kids. Watching him get admitted into ER, hearing his screams while these strange people are poking needles in his small body, taping oxygen tube on his face, taping sensors to his body, and on and on and on... At such a young age, every piece of tape seem to cover his whole body. The IV they set up on his hand (incase he's unable to feed) seem to take up the entire arm! And he was too young to control his hand with the extra weight, and he would knock himself in the head constantly...

All of these does not compare to watching his face turn purple/black when he's coughing. We were to time the cough and record his color. During the worst stage, his coughs would last about 1 minute and he would only rest another 2-3 minutes before the next episode of cough comes on. Even now, over a year later, thinking about the experience brings tears.

I would not want to be responsible for causing any other child or parent to go through this. And in those cased where the child died, my heart truely goes out to the parents because there's nothing we can do. You just watch them cough and cough and watch their face turn color...

I don't think it's necessary to have the child get EVERY immune shot they offer. But I think the parents should find out about the result of NOT getting the immune shot before they make the decision. Certain immune shots may be offered just to decrease inconvenience on the caretaker. Others are to save the child's life. Please don't make a decision across the board on immune shots. It should be taken seriously and case by case. You may choose to not get one but get the other. Diane

For insight on the vaccination issue as requested by Luigi, read 'The Vaccination Decision' ('forgotten the author) which has indepth coverage on all angles, and all vaccines, including Pertussis.The Hahnemann clinic in Albany should have it. The figures in the SF chronicle are by no means realistic--many vaccine- realted deaths and illnesses are often not attributed to a vaccine, and therefore not recorded statistically as such. The politics of this issue are also covered in The Vaccine Decision.

There was also an indepth article in Mothering Magazine (possibly now sold out; check your library) I think in the summer of 1996 or 1997. The article interviewed many doctors on both sides of the issue. There is also a wealth of information and concerned parent's groups on the web.

See also The Alternative Medicine Guide for more info. And Smart Medicine for a Healthier Child by Janet Zand. Maura

Along with articles such as this one warning of the dangers of actively choosing to not-vaccinate your children should be a more information on the health history of the victims of the diseases. Children whose parents consciously choose not to vaccinate them because it supports a broader decision to take a active role in the health and nutrition of their children should not be put in the same risk group as those whose parents do not vaccinate because of neglect, ignorance of the potential danger, or other barriers such as language or resource. I would suppose that the risk for a formula feed baby in an impoverished environment contracting and dying from diphtheria would be greater than the risk for a breast feed baby at home. I would be more convinced about the effectiveness of vaccinations if along with the statistics came some patient demographics. Christine
I'm not so sure that environment will protect a child from whooping cough. When I was in college back in the early 70's, my mother cared for a neighbor's children. The baby, probably 4 months old, caught whooping cough. This was in an upper-middle class suburb. Californians are quite mobile. How can you guarantee that your baby won't come in contact with someone from a different environment, especially if you have older children who do get out in the world? I could list any number of people who have helped out at our house (including our house cleaner, who was hired when our son was born) who may be in this other category.

Also, I would do some research before believing that a breastfed child has some protection from pertussis. The 7/2 Chronicle article stated that the effect of the vaccine wears off after about 8 years. When was any of us last vaccinated for pertussis? It may be that if the vaccine is no longer effective, then you may not be carrying enough antibodies in your breast milk. Fran

Finally, as stated in the 7/2 Chronicle article, an unvaccinated child is putting other children at risk. If your kid is healthy but gets pertussis, then maybe it won't be so bad. But how do you know that he/she won't infect another kid who isn't as healthy and consequently suffers greatly?

On the issue of vaccinating kids or not, I would like to add my two cents, coming from a Third world country where the memory of how devastating these childhood diseases can be is still in people's minds. Many parents seem to be in favor of not vaccinating and I am sure they like to think of themselves as making an intelligent decision for their youngsters' health. Now, something that some of them seem to forget is that not vaccinating their children may very well have an effect,including death, on OTHER CHILDREN. The pertussis cases are a very good example. One four-year old, unvaccinated kid gets it and is not a big deal, he recovers; but then he passes it along to a one-month-old, maybe his own sibling. Of course all the one-month-olds are unvaccinated, because they only get the shot at two months. And the presence of a larger pool of the pertussis bacteria certainly increases the possibility of getting the disease in ALL kids, regardless of their parents ideas on vaccines.

Something contradictory, at least to me, is that many people that opt not to vaccinate will give their kids thirty different shots when they travel overseas to a poor country. Well, the diseases we are discussing here are as deadly as those over there! Irene

I don't have the statistics in front of me at the moment, but I think they said something like 1 out of 100,000 children get whooping cough. What I want to know is: How many of those children are exposed to the whooping cough bacteria? How many of those children have been vaccinated for it? And are those children living in an area where most of the population has been vaccinated or not? In other words, I think the statistics can be very misleading and perhaps give people a false idea about how easy or hard it is to get the disease.

The important questions, what parents *really* want to know, are: If my child gets exposed to the bacteria, how likely is he or she to catch the disease? How likely is my child to be exposed to the bacteria? What is likely to happen to my child if he/she is exposed to the bacteria and is not vaccinated? As I understand it, from what I have read, whooping cough is *highly* contagious, so an unvaccinated child who is exposed is very likely to get it. I also believe that the whooping cough bacteria is not that uncommon in the U.S. The reason, in my opinion, that the statistics show so few children contracting the disease is *most children are vaccinated*.

Just something else to keep in mind when making the decisions. Statistics can be misleading and you should consider carefully what they have really measured and what they are really showing... Caroline

Dr. William F. Haddon Food Safety and Health Western Regional Research Center Agricultural Research Service (ARS), USDA 800 Buchanan St. Albany, CA 94710 Date: Sun, 5 Jul 1998 11:06:56 -0400 (EDT) Subject: PRO/EDR Pertussis - USA (California) From: ProMED-mail PERTUSSIS - USA (CALIFORNIA) **************************** A ProMED-mail post Date: Fri, 3 Jul 1998 06:27:57 -0400 From: George A. Robertson Source: San Francisco Chronicle [excerpts - ES] Pertussis has recently claimed 2 lives in the San Francisco Bay area, a situation that calls for increased vigilance among area pediatricians. Pertussis tends to occur in cycles, particularly in communities resistant to vaccinating their children. According to state epidemiologist Cynthia O'Malley, there have been 198 cases of whooping cough in California this year, most of them in an arc stretching from Santa Cruz to Sacramento. The increase is particularly troubling in Santa Clara County, where 80 cases have been reported in the first six months of this year, nearly four times the 23 cases in all of last year. On April 4, a 2-month-old boy died shortly after he was transferred to a hospital from Kaiser Permanente's Santa Clara Medical Center. One month later, a 2-month-old Contra Costa County girl succumbed to the disease in an Oakland hospital. According to a spokeswoman for that hospital, there have been 12 serious cases of whooping cough referred to the hospital so far this year, compared with four cases last year. Betsy McCarty, Santa Cruz County chief of public health, is particularly concerned about the number of new cases in her communities. We feel like we're ground zero, she said. We've had 38 cases so far this year, compared to 42 in all of last year. That's of big concern to us. McCarty said the county's health department has set up a command center to track cases and to educate parents about just how dangerous whooping cough can be. This is one of the more lethal diseases for little babies, she said. Once you see a child under 1 year old with whooping cough, you never forget it -- to see those little things gasping for breath. _Bordetella pertussis_ [causes] a mild to severe bronchial infection in adults, but it can be deadly to children. Whooping cough begins as a chest cold, accompanied by fever and a worsening cough. The bacteria destroy the hairlike cilia, which line the bronchial tubes and sweep irritants out of the lungs. The body's response is to cough convulsively. When a child coughs out the last ounce of air from his or her lungs, and the lungs then rapidly re-inflate, they emit the ghastly whoop that gives pertussis its common name. Children who have it suffer terribly, and if they die, they die of suffocation brought about by their own coughing and vomiting. In rural areas of Sonoma County, where as many as half the schoolchildren are unvaccinated at the insistence of their parents, two family-related outbreaks helped boost whooping cough cases to 47 so far this year, compared with 44 in all of 1997. We do have a recurring problem here with a community which is averse to having their children vaccinated, said Dr. George Flores, Sonoma County director of public health. By their own choice, they are putting their children at risk of acquiring and transmitting whooping cough to their children or other people's children. Private and public health plans make the diphtheria-pertussis-tetanus vaccine virtually universally available to California children. Vaccinations are given at the age of 2, 4 and 6 months, followed by a booster shot at 12 to 15 months. Until a new and safer pertussis vaccine was placed on the market last year, children ran a 1-in-1,750 risk of seizure after being vaccinated with the DPT vaccine. Seizures -- surprisingly common with children -- are almost invariably mild. But as many as 10 of every 1 million children vaccinated suffer from swelling of the brain lining that can cause permanent brain damage. Mel Lippmann, disease control investigator for the San Francisco Department of Public Health, said pertussis remains persistent in the population because the effects of the vaccine wear off after about eight years. Older children and adults are susceptible to whooping cough, and they often contract it, but because their breathing passages are so much larger, they pass it off as a bad cold. Adults, in fact, serve as a reservoir for the bacteria. Before the original pertussis vaccine was introduced in 1949, the incidence of whooping cough was 150 cases per 100,000 Americans. The vaccine dropped it to 1.5 cases per 100,000, but it has been creeping back up since 1983, as more parents shun the vaccine for their children. A Vienna, Va.-based organization of parents whose children suffered reactions to vaccines, the National Vaccine Information Center, has been active in publicizing adverse reactions to childhood immunizations. The organization supports the right of citizens to make educated, independent vaccination decisions for themselves and their children, according to its Internet Web site, and reports that more than 1 billion dollars has been paid out to 1,000 victims since the National Childhood Vaccine Injury Act was passed in 1986. But Santa Cruz County public health chief McCarty said society is now paying a price for the talk-show chat about the alleged dangers of childhood vaccines. The risk of death from pertussis is 1 in every 200 cases. Even in a vaccinated population, the risk of whooping cough is estimated to be 10 in 100,000. The problem is that we have had such success with childhood vaccination that people have forgotten what these diseases are like, said McCarty. People who think they are doing the right thing are not getting their children vaccinated. They couldn't be more mistaken. This is as important as putting your kid in the car seat, seeing they have enough to eat and locking up the poisons. -- ProMED-mail