JOANNE FARYON: Hello, Iím Joanne Faryon. Welcome to tonightís special, When Immunity
Fails: The Whooping Cough Epidemic. Weíll explore the worst whooping cough outbreak
in California in more than 60 years. Just why is a disease that was nearly extinct thirty
years ago, finding its way back not just in this state, but in other parts of the country
as well? What we learned may surprise you. There are serious questions about how well
the vaccine to prevent the disease works; questions government health officials have
been slow to even ask. KPBS teamed up with the Watchdog Institute, an investigative journalism
center at San Diego State University, and Radio Netherlands Worldwide to tell this story.
A story that took us across California and overseas to Amsterdam. But first, we begin
in a delivery room in a San Diego hospital, where a mother has just given birth to her
third son.
[ baby crying ]
Matthew Jacob Bryce was born Oct 11, 2010. A healthy baby boy, the third boy for Cindy
and Marlon Bryce. Matthew started showing signs of a cold when he was just two weeks
old. The Bryce family knew something was wrong.
MARLON BRYCE: So it just seemed like this cold it was just affecting his breathing.
FARYON: The family was aware of the whooping cough epidemic in California, from news reports
REPORTER: State health officials say more than 6,400 cases of whooping cough have been
reported this year.
FARYON: And their pediatrician.
BRYCE: There wasnít any whooping or they always say there is a whooping or a cough,
he didnít have a cough or anything it was just that there was a cold.
FARYON: Matthewís doctor suspected it could be whooping cough, also known as pertussis.
She took a nasal swab and sent it to the lab. She also started Matthew on antibiotics. Six
days later, with Matthew just 23 days old, Cindy Bryce got a phone call from the California
Department of Health. The diagnosis was whooping cough.
M. BRYCE: The moment I heard it I just immediately started thinking the worst because you have
heard the news about the babies that have passed away.
FARYON: From January to October this year, 10 newborns in California died from whooping
cough, two in San Diego County. More than 7,000 children and adults got sick from the
disease - the highest number in the state in more than 60 years. Just how did Matthew
and so many others come down with a disease that is supposed to be preventable with a
vaccine? Tonight weíll raise questions about the effectiveness of that vaccine. A four-month
investigation by KPBS and the Watchdog Institute, found many people who have been diagnosed
with whooping cough were immunized. We also show how government data on the number of
people diagnosed with whooping cough lacks timeliness and is often inconsistent, begging
the question: just who is keeping track of this epidemic?
Weíll show you how some of the experts who influence vaccine policy are financially tied
to vaccine companies. And, weíll follow the Bryce family as they struggle with their sonís
diagnosis, and the setbacks in his recovery. Whooping cough, violent cough, the hundred-day
cough; all names for pertussis.
DR. JAMES CHERRY: What causes the cough actually we donít knowÖ thereís no other cough quite
like it.
FARYON: Pertussis is a respiratory illness caused by the bacterium bordetella pertussis.
At first, it can mimic a cold. But later produces a violent and persistent cough, a cough that
leaves children gasping for air ñ creating the distinct whooping sound. For adults, whooping
cough may only be a nuisance. In fact scientists estimate more than 80 percent of adult cases
are never diagnosed because most people assume they just have a bad cold. But to infants
whooping cough can be deadly, especially if not diagnosed early.
DR. JAMES CHERRY: So with infection that you eventually clear the bacteria and you get
better. But it's a prolonged, a good percentage of cases will last one or two months.
DR. FRITS MOOI: After a pertussis infection it has been shown to get super infections,
in fact that is one of the main complications, pneumonia.
FARYON: Young babies arenít able to cough up secretions that collect in their lungs,
leading to pneumonia and making it difficult to breathe. Early antibiotic treatment is
most critical in this age group. Whooping cough was nearly wiped out by the late 1970ís
because of mass immunization, but itís somehow found its way back to California and other
highly vaccinated communities around the world. Just why itís made such a vengeful comeback
has two of the worldís leading whooping cough experts in disagreement.
Dr. James Cherry of UCLA:
CHERRY: The main reason is increased awareness.
FARYON: and Dr. Frits Mooi of the Netherlands Centre for Infectious Diseases Control.
MOOI: We found really a new mutation in the bug.
FARYON: Dr. Mooi and Dr. Cherry both began their research into Whooping Cough about 30
years ago. Cherry in the U.S. and Mooi in The Netherlands. The two scientists know each
other's work.
CHERRY: First of all, his molecular microbiological is, he's right at the top of scholars. There's
no question about that. I think where some of the things he's published is the clinical
data are not very good.
MOOI: I don't communicate too much with him but what he wrote in the press is that I screw
up epidemiology. That doesn't help me too much.
FARYON: To understand why these two experts disagree, you need to know a little about
the history of the pertussis vaccine.
ANNOUNCER: Since most serious cases occur before school age, immunization in school
may be too late.
FARYON: The bacteria that causes whooping cough was first isolated in Belgium in 1906.
At the time, the illness was one of the leading causes of infant death.
ANNOUNCER: In 1921, whooping cough killed 316 Michigan children. Last year, the number
of deaths was reduced to 63.
FARYON: The discovery lead to the first attempts at a vaccine. But it wasnít until the late
1940ís scientists developed a vaccine effective enough to prevent whooping cough.
ANNOUNCER: Unlike the disease however, a vaccine does not endanger life.
FARYON: By 1946, mass immunization programs began in the U.S. and the number of cases
dropped dramatically. Prior to the vaccine the rate of disease was 157 cases per 100,000.
By the 1970ís, with large scale immunizations, fewer than one in one hundred thousand people
got whooping cough. But the vaccine was not without controversy. The early versions were
associated with side effects such as prolonged crying spells and seizures in babies. By 1996,
the FDA approved a new whooping cough vaccine. It was called an acellular version. That means
the vaccine uses only purified components of the disease-causing organism. That vaccine
was considered to be safer and associated with few mild side effects. Today, the U.S.
uses only the acellular pertussis vaccine. But as the United States was changing vaccines
something else was happening ñ health officials across the country were reporting increasing
numbers of positive whooping cough cases. And in a government lab about 30 minutes outside
of Amsterdam, a group of scientists had discovered something else ñ the bacterium that causes
whooping cough started to look a little different.
MOOI: This new mutation had the effect that the bacteria started to produce more pertussis
toxin.
FARYON: Just whether that mutation is to blame, at least in part, for the California epidemic
and outbreaks elsewhere in the world is at the heart of the whooping cough debate. Dr.
Mooi believes this to be the case, but not Dr. Cherry.
CHERRY: Even though these changes have occurred there is no evidence that thatís lead to
increased vaccine failure.
FARYON: Here in San Diego County, more than 85 percent of children are immunized. In fact,
less than three percent of kids entering kindergarten have not been immunized because of their familyís
personal beliefs. But despite the high immunization rate, San Diego has the second largest number
of positive whooping cough cases in California. Dr. Dean Sidelinger is San Diegoís deputy
public health officer.
DR. DEAN SIDELINGER: This is a disease that if someone has it itís very easy to transfer
from one person to another. So if you or I sitting here during this interview, one of
us had pertussis chances are we could transmit that to the other person.
Sidelinger says in the past, the number of whooping cough cases peaked in summer and
slowed by fall, but this year, that didnít happen.
SIDELINGER: So as time goes on weíre seeing more cases. We know that public awareness
plays into that as we talk about pertussis more people are asking their doctors and doctors
are asking their patients weíre going to see more, but that trend continued.
FARYON: By the end of November 2010, nearly 1000 infants, children and adults in San Diego
County tested positive for whooping cough. More than half of them had been immunized.
Our investigation shows that trend continues throughout California. KPBS and The Watchdog
Institute collected data from 9 California counties that report some of the highest infection
rates. Our research shows that where immunization history is known, between 44 and 83 percent
of people diagnosed with whooping cough were vaccinated. We looked at California Department
of Public Health records too. In cases where vaccination history was recorded, more than
80 percent of infected people had been immunized.
DR. MARK HORTON: From the epidemiology experts and the experts in vaccine that this is absolutely
expected.
FARYON: Dr. Mark Horton is the director of the California Department of Public Health.
HORTON: If you've got a percentage of the population vaccinated and a percentage of
those vaccinated that are still susceptible because the vaccine isn't perfectly effective
or effective in all individuals, when you work out the arithmetic you'll see that even
with a very effective vaccine, and even if you have the majority of the population vaccinated,
the pool of susceptibles will include a number of individuals that have never been vaccinated
but will also include quite a few and in some cases greater than 50 percent of the individuals
have been previously vaccinated.
FARYON: In other words, if you do the math, you will always find a certain number of immunized
people getting sick if a vaccine is not 100 percent effective.
HORTON: So thatís no surprise to us nor is it a reflection on the efficacy of the vaccine.
REPORTER KEVIN CROWE: Itís not a reflection on the efficacy of the vaccine?
HORTON: Correct, correct.
FARYON: But 20 years ago, the reverse was true. According to a report by the Centers
for Disease Control, more than half of the children between 3 months and 4 years old
who got whooping cough nationwide between 1990 and 1996 were not immunized. The rate
of whooping cough has also been increasing for the past 20 years. From less than one
in 100,000 to 18 per 100,000 here in California. And in some California counties such as San
Luis Obispo, rates are nearly as high as before vaccines were developed. Two days after our
interview with the Bryce family, Matthew got a fever. He was hospitalized at Radyís Childrenís
Hospital in San Diego. Matthew was not immunized against whooping cough. Heís too young. Babies
canít be immunized until theyíre two months old.
But everyone else in the Bryce family was vaccinated ñ even his parents got booster
shots. The practice of immunizing everyone around a newborn baby is called cocooning.
CINDY BRYCE: When I called the doctor they asked me who has it and I couldnít give them
an answer because I donít know where he got it from because everyoneís been vaccinated.
FARYON: Myron and one of his sons were also tested for whooping cough ñ both were negative.
M. BRYCE: The one thing I would want to know is the vaccine working? Is it as effective
because before this I thought the vaccine was working and I thought that if I did everything
that I was told to do that our sons would be protected.
FARYON: Just how effective is the vaccine? That all depends on who you talk to. Drug
information included with the two most commonly used whooping cough vaccines in the US say
the vaccine is 85 percent effective.
MOOI: This new strain has completely invaded the Netherlands and also other countries and
pushed out all the other strains. Itís quite unique.
FARYON: Dr. Mooi believes thereís no way to determine how effective the vaccines are
because they have not been tested against the new strain of whooping cough.
MOOI: We call it the p3 strain.
FARYON: A strain he believes is more virulent and can make people sicker. This strain emerged
while the new acellular vaccines were being developed.
MOOI: I can tell you one of the reasons the vaccine companies is not too happy with me
is because if what I say is true they selected the wrong strains the in the 1980ís.
FARYON: Mooiís lab was studying the new strain when The Netherlands experienced an unexpected
whooping cough epidemic in 1996.
MOOI: There were more strains in fact when you compare the two there was a very direct
relationship between the emergence of these strains, we call them p3 strains and the increase
in pertussis notifications.
CHERRY: Thereís absolutely no evidence that either of the two vaccines that are most common
today used in the U.S. that there is increased vaccine failure with either of those vaccines.
FARYON: So if you had to explain why weíre seeing this epidemic the highest number of
cases in 60 years, what would you tell people?
CHERRY: The main reason is increased awareness. People, particularly public health people
are much more aware and that trickles down.
FARYON: Cherry says the increase is also due in part because of something called waning
immunity. Immunity to whooping cough does not last a lifetime, whether you are vaccinated
or develop natural immunity from getting the disease. Almost all experts agree waning immunity
is contributing to whooping cough outbreaks worldwide. Where they disagree: when does
immunity fail? Dr. Mooi believes the new strain of pertussis causes immunity to fail sooner
than in the past. And heís published his findings in several peer reviewed journals
including the CDCís Infectious Diseases.
MOOI: When the immunity is sub-optimal what will happen the bacteria will not be recognized
very well by the immune system because of the mismatch and second of all even if immune
response is started in the body the toxin will be able to delay it. You could say these
two changes work together by decreasing the period of which the vaccine is protective
further.
FARYON: The Netherlands learned something else after its 1996 epidemic. At the time,
it had very few samples of the bacteria that was causing people to get sick. So Mooiís
lab began asking doctors and their labs to send him positive pertussis swabs. His lab
now has 3,000 samples. California that has collected just 29 samples from the more than
7,000 whooping cough cases in the state. During the KPBS/Watchdog four month investigation,
we also learned data kept by the state and the CDC was often lagging behind county data
and was inconsistent. While counties like San Diego knew the immunization status of
the vast majority of people with whooping cough, the stateís data listed the information
as unknown. Despite statewide protocols for reporting pertussis, a KPBS/Watchdog survey
found some counties donít follow them or are slow to report the information
HORTON: Thereís a perception that the more numbers the better, but let me be very clear
we in no way need reports on every single case of pertussis for us to make important
judgments and decisions about whatís happening.
FARYON: The CDC in Atlanta declined our requests for an interview. In an email response they
said it is ìdifficult to disentangle all the factorsî contributing to increases in
pertussis, but listed ìincreasing transmission, better recognition, and increased laboratory
confirmation.î We also asked whether a new more virulent strain could be contributing
to the outbreak. The CDCís response: ìAvailable data do not suggest that ptxP3 is more virulent,
or that increasing reports are attributable only to the emergence of ptxP3. We continue
to work on this and other potential explanations for the increase in pertussis that has occurred
since the 1980s.î The CDC sent us this study by their own investigators. The study looked
at children between 6 months and five years old. It found pertussis vaccines to be more
than 90 percent effective. The study looked at data between 1998 and 2001. It did not
collect pertussis strain information.
SINGING: Do you happen to know what a T-dap is? It's a special vaccine but it's not just
for kids.
FARYON: Sanofi Pastuer, one of two companies that make the vaccine widely used in the U.S.,
sponsored this singing competition earlier this year.
SINGING: Persussis is the reason why you should call your doctor today.
FARYON:
It was a public relations exercise to get the word out about whooping cough and immunization.
But just where is the line between good PR and trying to influence public health policy?
SINGING: Take a shot and give pertussis a whooping.
FARYON: Especially when public health policy can increase vaccine sales. Since 2007, the
California department of health has spent more than $200 million on pertussis vaccines
for children on medical or who are under-insured. And itís sure to rise. In September, the
California state legislature passed a law requiring all students to receive another
does, a sixth dose of the pertussis vaccine before entering middle school. It may be a
case of whatís good for business is also good for public health. But how much influence
does industry have over public health policy? Sanofi Pasteur also established and funds
The Global Pertussis Initiative. A group made up of medical experts from around the world.
The GPI was established 10 years ago to study why pertussis was making a comeback and find
ways to control the disease. More than half its members are employees of the pharmaceutical
company or receive research money or consulting fees. Public officials from across the country,
including California and the CDC, site the Global Pertussis Initiative when making vaccine
policy. Dr. James Cherry is a member of the initiative.
Heís also received speaking fees and research funds from vaccine manufacturers. At the same
time, he sat on government committees to help determine vaccine policy and efficacy.
FARYON: A cynic might say that if you have a community of experts in pertussis as in
the Global Pertussis Initiative, who primarily their work in terms of this endeavor is being
funded by the drug company that makes the vaccine, there might be less incentive to
say make a new vaccine and more incentive to say just use the old one more often. What
do you say to them?
CHERRY: I donít think thatís true. I think that weíve been talking about new vaccines.
It think the difficulty with the new vaccine lies in the expense that it would cost to
make a new vaccine and the difficulty in testing it and FDA requirements for it and I think
if the climate was right for two of the major manufacturers they would do it.
MOOI: And these are three different pertussis strains.
FARYON: Dr. Mooi is a critic of the Pertussis Initiative.
MOOI: My big disappointment is they have totally and I think willfully ignored pathogen adaptation.
I think a few years ago we had the year that Darwin died 100 year ago, it was not so long
ago, I think it's very strange that evolution and pathogen adaptation is completely ignored
by such a group. I find that bad for science and bad for public health.
FARYON: Sanofi Pastuer released this statement to KPBS and the Watchdog Institute. It says
its grant to the GPI brings the world's authorities on pertussis together and that benefits society
as a whole. The company also says ìat the present time, there is no evidence to suggest
current pertussis vaccines lack effectiveness.î Dr. Dean Sidelinger was one of the first health
officials to learn immunized people were getting sick in his county. He said he was surprised,
but in the end, he says the current vaccine is still the best thing heís got to protect
his community.
SIDELINGER: It does significantly decrease the pertussis we see a significantly lower
number of pertussis cases now then we saw before we started using the vaccine. So we
donít want people to feel complacent to say I donít want that vaccine because Iíve seen
many of the cases that have been reported were fully vaccinated.
FARYON: Sidelinger says there would be many more cases if there was no vaccine at all.
Dr. Mooi agrees. He believes public health officials should be encouraging cocooning,
immunizing all those around newborn babies. But in the long run, he says we need better
vaccines. Baby Matthew spent four days in the hospital and was eventually discharged.
Today, heís getting his two-month routine check-up.
DOCTOR: I think it was just back luck heís had two illnesses in a row and now the cold
he's building up his immunity.
FARYON: Despite a stuffy nose, Matthew is doing well today.
DCOTOR: As you might know the vaccine is not as effective as we want it to be. And that's
one reason why there've been a lot of cases. But with Matthew in particular, his own immunity
has kicked in from having the illness, that is, in effect a sort of a booster that will
protect him going forward. And how long that immunity lasts is still a question.
MARLON: The one thing I would want to say to parents is just watch your kids, just be concerned. Because at first we thought
we were being over protective. But Iím glad we were just a little bit over-concerned.
FARYON: Since KPBS and the Watchdog Institute began its investigation, state health officials,
the CDC and scientists from UCLA, including Dr. James Cherry, began a new study to determine
whether the new strain of pertussis is contributing to the current whooping cough outbreak. For
more on this story, and to see more of the data collected in our investigation, go to
kpbs.org/whoopingcough and watchdoginstitute.org. For KPBS, the Watchdog Institute and Radio
Netherlands Worldwide, Iím Joanne Faryon. Thanks for watching.