WEBVTT

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JOANNE FARYON: Hello, Iím Joanne Faryon.
Welcome to tonightís special, When Immunity

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Fails: The Whooping Cough Epidemic. Weíll
explore the worst whooping cough outbreak

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in California in more than 60 years. Just
why is a disease that was nearly extinct thirty

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years ago, finding its way back not just in
this state, but in other parts of the country

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as well? What we learned may surprise you.
There are serious questions about how well

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the vaccine to prevent the disease works;
questions government health officials have

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been slow to even ask. KPBS teamed up with
the Watchdog Institute, an investigative journalism

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center at San Diego State University, and
Radio Netherlands Worldwide to tell this story.

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A story that took us across California and
overseas to Amsterdam. But first, we begin

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in a delivery room in a San Diego hospital,
where a mother has just given birth to her

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third son.

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[ baby crying ]

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Matthew Jacob Bryce was born Oct 11, 2010.
A healthy baby boy, the third boy for Cindy

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and Marlon Bryce. Matthew started showing
signs of a cold when he was just two weeks

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old. The Bryce family knew something was wrong.

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MARLON BRYCE: So it just seemed like this
cold it was just affecting his breathing.

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FARYON: The family was aware of the whooping
cough epidemic in California, from news reports

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REPORTER: State health officials say more
than 6,400 cases of whooping cough have been

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reported this year.

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FARYON: And their pediatrician.

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BRYCE: There wasnít any whooping or they
always say there is a whooping or a cough,

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he didnít have a cough or anything it was
just that there was a cold.

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FARYON: Matthewís doctor suspected it could
be whooping cough, also known as pertussis.

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She took a nasal swab and sent it to the lab.
She also started Matthew on antibiotics. Six

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days later, with Matthew just 23 days old,
Cindy Bryce got a phone call from the California

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Department of Health. The diagnosis was whooping
cough.

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M. BRYCE: The moment I heard it I just immediately
started thinking the worst because you have

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heard the news about the babies that have
passed away.

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FARYON: From January to October this year,
10 newborns in California died from whooping

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cough, two in San Diego County. More than
7,000 children and adults got sick from the

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disease - the highest number in the state
in more than 60 years. Just how did Matthew

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and so many others come down with a disease
that is supposed to be preventable with a

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vaccine? Tonight weíll raise questions about
the effectiveness of that vaccine. A four-month

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investigation by KPBS and the Watchdog Institute,
found many people who have been diagnosed

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with whooping cough were immunized. We also
show how government data on the number of

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people diagnosed with whooping cough lacks
timeliness and is often inconsistent, begging

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the question: just who is keeping track of
this epidemic?

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Weíll show you how some of the experts who
influence vaccine policy are financially tied

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to vaccine companies. And, weíll follow the
Bryce family as they struggle with their sonís

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diagnosis, and the setbacks in his recovery.
Whooping cough, violent cough, the hundred-day

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cough; all names for pertussis.

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DR. JAMES CHERRY: What causes the cough actually
we donít knowÖ thereís no other cough quite

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like it.

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FARYON: Pertussis is a respiratory illness
caused by the bacterium bordetella pertussis.

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At first, it can mimic a cold. But later produces
a violent and persistent cough, a cough that

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leaves children gasping for air ñ creating
the distinct whooping sound. For adults, whooping

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cough may only be a nuisance. In fact scientists
estimate more than 80 percent of adult cases

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are never diagnosed because most people assume
they just have a bad cold. But to infants

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whooping cough can be deadly, especially if
not diagnosed early.

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DR. JAMES CHERRY: So with infection that you
eventually clear the bacteria and you get

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better. But it's a prolonged, a good percentage
of cases will last one or two months.

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DR. FRITS MOOI: After a pertussis infection
it has been shown to get super infections,

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in fact that is one of the main complications,
pneumonia.

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FARYON: Young babies arenít able to cough
up secretions that collect in their lungs,

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leading to pneumonia and making it difficult
to breathe. Early antibiotic treatment is

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most critical in this age group. Whooping
cough was nearly wiped out by the late 1970ís

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because of mass immunization, but itís somehow
found its way back to California and other

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highly vaccinated communities around the world.
Just why itís made such a vengeful comeback

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has two of the worldís leading whooping cough
experts in disagreement.

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Dr. James Cherry of UCLA:

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CHERRY: The main reason is increased awareness.

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FARYON: and Dr. Frits Mooi of the Netherlands
Centre for Infectious Diseases Control.

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MOOI: We found really a new mutation in the
bug.

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FARYON: Dr. Mooi and Dr. Cherry both began
their research into Whooping Cough about 30

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years ago. Cherry in the U.S. and Mooi in
The Netherlands. The two scientists know each

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other's work.

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CHERRY: First of all, his molecular microbiological
is, he's right at the top of scholars. There's

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no question about that. I think where some
of the things he's published is the clinical

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data are not very good.

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MOOI: I don't communicate too much with him
but what he wrote in the press is that I screw

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up epidemiology. That doesn't help me too
much.

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FARYON: To understand why these two experts
disagree, you need to know a little about

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the history of the pertussis vaccine.

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ANNOUNCER: Since most serious cases occur
before school age, immunization in school

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may be too late.

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FARYON: The bacteria that causes whooping
cough was first isolated in Belgium in 1906.

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At the time, the illness was one of the leading
causes of infant death.

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ANNOUNCER: In 1921, whooping cough killed
316 Michigan children. Last year, the number

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of deaths was reduced to 63.

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FARYON: The discovery lead to the first attempts
at a vaccine. But it wasnít until the late

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1940ís scientists developed a vaccine effective
enough to prevent whooping cough.

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ANNOUNCER: Unlike the disease however, a vaccine
does not endanger life.

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FARYON: By 1946, mass immunization programs
began in the U.S. and the number of cases

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dropped dramatically. Prior to the vaccine
the rate of disease was 157 cases per 100,000.

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By the 1970ís, with large scale immunizations,
fewer than one in one hundred thousand people

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got whooping cough. But the vaccine was not
without controversy. The early versions were

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associated with side effects such as prolonged
crying spells and seizures in babies. By 1996,

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the FDA approved a new whooping cough vaccine.
It was called an acellular version. That means

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the vaccine uses only purified components
of the disease-causing organism. That vaccine

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was considered to be safer and associated
with few mild side effects. Today, the U.S.

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uses only the acellular pertussis vaccine.
But as the United States was changing vaccines

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something else was happening ñ health officials
across the country were reporting increasing

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numbers of positive whooping cough cases.
And in a government lab about 30 minutes outside

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of Amsterdam, a group of scientists had discovered
something else ñ the bacterium that causes

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whooping cough started to look a little different.

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MOOI: This new mutation had the effect that
the bacteria started to produce more pertussis

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toxin.

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FARYON: Just whether that mutation is to blame,
at least in part, for the California epidemic

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and outbreaks elsewhere in the world is at
the heart of the whooping cough debate. Dr.

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Mooi believes this to be the case, but not
Dr. Cherry.

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CHERRY: Even though these changes have occurred
there is no evidence that thatís lead to

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increased vaccine failure.

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FARYON: Here in San Diego County, more than
85 percent of children are immunized. In fact,

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less than three percent of kids entering kindergarten
have not been immunized because of their familyís

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personal beliefs. But despite the high immunization
rate, San Diego has the second largest number

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of positive whooping cough cases in California.
Dr. Dean Sidelinger is San Diegoís deputy

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public health officer.

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DR. DEAN SIDELINGER: This is a disease that
if someone has it itís very easy to transfer

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from one person to another. So if you or I
sitting here during this interview, one of

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us had pertussis chances are we could transmit
that to the other person.

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Sidelinger says in the past, the number of
whooping cough cases peaked in summer and

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slowed by fall, but this year, that didnít
happen.

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SIDELINGER: So as time goes on weíre seeing
more cases. We know that public awareness

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plays into that as we talk about pertussis
more people are asking their doctors and doctors

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are asking their patients weíre going to
see more, but that trend continued.

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FARYON: By the end of November 2010, nearly
1000 infants, children and adults in San Diego

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County tested positive for whooping cough.
More than half of them had been immunized.

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Our investigation shows that trend continues
throughout California. KPBS and The Watchdog

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Institute collected data from 9 California
counties that report some of the highest infection

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rates. Our research shows that where immunization
history is known, between 44 and 83 percent

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of people diagnosed with whooping cough were
vaccinated. We looked at California Department

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of Public Health records too. In cases where
vaccination history was recorded, more than

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80 percent of infected people had been immunized.

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DR. MARK HORTON: From the epidemiology experts
and the experts in vaccine that this is absolutely

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expected.

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FARYON: Dr. Mark Horton is the director of
the California Department of Public Health.

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HORTON: If you've got a percentage of the
population vaccinated and a percentage of

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those vaccinated that are still susceptible
because the vaccine isn't perfectly effective

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or effective in all individuals, when you
work out the arithmetic you'll see that even

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with a very effective vaccine, and even if
you have the majority of the population vaccinated,

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the pool of susceptibles will include a number
of individuals that have never been vaccinated

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but will also include quite a few and in some
cases greater than 50 percent of the individuals

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have been previously vaccinated.

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FARYON: In other words, if you do the math,
you will always find a certain number of immunized

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people getting sick if a vaccine is not 100
percent effective.

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HORTON: So thatís no surprise to us nor is
it a reflection on the efficacy of the vaccine.

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REPORTER KEVIN CROWE: Itís not a reflection
on the efficacy of the vaccine?

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HORTON: Correct, correct.

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FARYON: But 20 years ago, the reverse was
true. According to a report by the Centers

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for Disease Control, more than half of the
children between 3 months and 4 years old

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who got whooping cough nationwide between
1990 and 1996 were not immunized. The rate

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of whooping cough has also been increasing
for the past 20 years. From less than one

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in 100,000 to 18 per 100,000 here in California.
And in some California counties such as San

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Luis Obispo, rates are nearly as high as before
vaccines were developed. Two days after our

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interview with the Bryce family, Matthew got
a fever. He was hospitalized at Radyís Childrenís

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Hospital in San Diego. Matthew was not immunized
against whooping cough. Heís too young. Babies

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canít be immunized until theyíre two months
old.

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But everyone else in the Bryce family was
vaccinated ñ even his parents got booster

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shots. The practice of immunizing everyone
around a newborn baby is called cocooning.

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CINDY BRYCE: When I called the doctor they
asked me who has it and I couldnít give them

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an answer because I donít know where he got
it from because everyoneís been vaccinated.

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FARYON: Myron and one of his sons were also
tested for whooping cough ñ both were negative.

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M. BRYCE: The one thing I would want to know
is the vaccine working? Is it as effective

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because before this I thought the vaccine
was working and I thought that if I did everything

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that I was told to do that our sons would
be protected.

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FARYON: Just how effective is the vaccine?
That all depends on who you talk to. Drug

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information included with the two most commonly
used whooping cough vaccines in the US say

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the vaccine is 85 percent effective.

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MOOI: This new strain has completely invaded
the Netherlands and also other countries and

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pushed out all the other strains. Itís quite
unique.

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FARYON: Dr. Mooi believes thereís no way
to determine how effective the vaccines are

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because they have not been tested against
the new strain of whooping cough.

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MOOI: We call it the p3 strain.

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FARYON: A strain he believes is more virulent
and can make people sicker. This strain emerged

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while the new acellular vaccines were being
developed.

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MOOI: I can tell you one of the reasons the
vaccine companies is not too happy with me

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is because if what I say is true they selected
the wrong strains the in the 1980ís.

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FARYON: Mooiís lab was studying the new strain
when The Netherlands experienced an unexpected

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whooping cough epidemic in 1996.

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MOOI: There were more strains in fact when
you compare the two there was a very direct

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relationship between the emergence of these
strains, we call them p3 strains and the increase

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in pertussis notifications.

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CHERRY: Thereís absolutely no evidence that
either of the two vaccines that are most common

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today used in the U.S. that there is increased
vaccine failure with either of those vaccines.

00:14:55.759 --> 00:15:01.870
FARYON: So if you had to explain why weíre
seeing this epidemic the highest number of

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cases in 60 years, what would you tell people?

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CHERRY: The main reason is increased awareness.
People, particularly public health people

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are much more aware and that trickles down.

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FARYON: Cherry says the increase is also due
in part because of something called waning

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immunity. Immunity to whooping cough does
not last a lifetime, whether you are vaccinated

00:15:24.779 --> 00:15:30.810
or develop natural immunity from getting the
disease. Almost all experts agree waning immunity

00:15:30.810 --> 00:15:36.879
is contributing to whooping cough outbreaks
worldwide. Where they disagree: when does

00:15:36.879 --> 00:15:43.879
immunity fail? Dr. Mooi believes the new strain
of pertussis causes immunity to fail sooner

00:15:46.560 --> 00:15:51.100
than in the past. And heís published his
findings in several peer reviewed journals

00:15:51.100 --> 00:15:53.709
including the CDCís Infectious Diseases.

00:15:53.709 --> 00:16:00.709
MOOI: When the immunity is sub-optimal what
will happen the bacteria will not be recognized

00:16:02.660 --> 00:16:09.660
very well by the immune system because of
the mismatch and second of all even if immune

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response is started in the body the toxin
will be able to delay it. You could say these

00:16:17.269 --> 00:16:24.269
two changes work together by decreasing the
period of which the vaccine is protective

00:16:25.230 --> 00:16:25.860
further.

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FARYON: The Netherlands learned something
else after its 1996 epidemic. At the time,

00:16:31.040 --> 00:16:36.670
it had very few samples of the bacteria that
was causing people to get sick. So Mooiís

00:16:36.670 --> 00:16:42.040
lab began asking doctors and their labs to
send him positive pertussis swabs. His lab

00:16:42.040 --> 00:16:48.240
now has 3,000 samples. California that has
collected just 29 samples from the more than

00:16:48.240 --> 00:16:55.120
7,000 whooping cough cases in the state.
During the KPBS/Watchdog four month investigation,

00:16:55.120 --> 00:17:01.160
we also learned data kept by the state and
the CDC was often lagging behind county data

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and was inconsistent. While counties like
San Diego knew the immunization status of

00:17:06.050 --> 00:17:10.490
the vast majority of people with whooping
cough, the stateís data listed the information

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as unknown. Despite statewide protocols for
reporting pertussis, a KPBS/Watchdog survey

00:17:16.799 --> 00:17:21.839
found some counties donít follow them or
are slow to report the information

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HORTON: Thereís a perception that the more
numbers the better, but let me be very clear

00:17:27.870 --> 00:17:34.870
we in no way need reports on every single
case of pertussis for us to make important

00:17:35.419 --> 00:17:38.140
judgments and decisions about whatís happening.

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FARYON: The CDC in Atlanta declined our requests
for an interview. In an email response they

00:17:44.070 --> 00:17:49.510
said it is ìdifficult to disentangle all
the factorsî contributing to increases in

00:17:49.510 --> 00:17:56.500
pertussis, but listed ìincreasing transmission,
better recognition, and increased laboratory

00:17:56.500 --> 00:18:00.990
confirmation.î We also asked whether a new
more virulent strain could be contributing

00:18:00.990 --> 00:18:07.990
to the outbreak. The CDCís response: ìAvailable
data do not suggest that ptxP3 is more virulent,

00:18:08.309 --> 00:18:15.029
or that increasing reports are attributable
only to the emergence of ptxP3. We continue

00:18:15.029 --> 00:18:21.490
to work on this and other potential explanations
for the increase in pertussis that has occurred

00:18:21.490 --> 00:18:27.610
since the 1980s.î The CDC sent us this study
by their own investigators. The study looked

00:18:27.610 --> 00:18:33.080
at children between 6 months and five years
old. It found pertussis vaccines to be more

00:18:33.080 --> 00:18:40.080
than 90 percent effective. The study looked
at data between 1998 and 2001. It did not

00:18:40.409 --> 00:18:42.419
collect pertussis strain information.

00:18:42.419 --> 00:18:49.419
SINGING: Do you happen to know what a T-dap
is? It's a special vaccine but it's not just

00:18:50.220 --> 00:18:52.620
for kids.

00:18:52.620 --> 00:18:59.190
FARYON: Sanofi Pastuer, one of two companies
that make the vaccine widely used in the U.S.,

00:18:59.190 --> 00:19:02.320
sponsored this singing competition earlier
this year.

00:19:02.320 --> 00:19:02.750
SINGING: Persussis is the reason why you should
call your doctor today.

00:19:02.750 --> 00:19:09.640
FARYON:

00:19:09.640 --> 00:19:15.100
It was a public relations exercise to get
the word out about whooping cough and immunization.

00:19:15.100 --> 00:19:20.640
But just where is the line between good PR
and trying to influence public health policy?

00:19:20.640 --> 00:19:25.190
SINGING: Take a shot and give pertussis a
whooping.

00:19:25.190 --> 00:19:31.900
FARYON: Especially when public health policy
can increase vaccine sales. Since 2007, the

00:19:31.900 --> 00:19:37.450
California department of health has spent
more than $200 million on pertussis vaccines

00:19:37.450 --> 00:19:44.450
for children on medical or who are under-insured.
And itís sure to rise. In September, the

00:19:44.520 --> 00:19:50.240
California state legislature passed a law
requiring all students to receive another

00:19:50.240 --> 00:19:56.110
does, a sixth dose of the pertussis vaccine
before entering middle school. It may be a

00:19:56.110 --> 00:20:01.150
case of whatís good for business is also
good for public health. But how much influence

00:20:01.150 --> 00:20:07.309
does industry have over public health policy?
Sanofi Pasteur also established and funds

00:20:07.309 --> 00:20:13.809
The Global Pertussis Initiative. A group made
up of medical experts from around the world.

00:20:13.809 --> 00:20:19.720
The GPI was established 10 years ago to study
why pertussis was making a comeback and find

00:20:19.720 --> 00:20:24.309
ways to control the disease. More than half
its members are employees of the pharmaceutical

00:20:24.309 --> 00:20:30.190
company or receive research money or consulting
fees. Public officials from across the country,

00:20:30.190 --> 00:20:36.029
including California and the CDC, site the
Global Pertussis Initiative when making vaccine

00:20:36.029 --> 00:20:40.140
policy. Dr. James Cherry is a member of the
initiative.

00:20:40.140 --> 00:20:46.010
Heís also received speaking fees and research
funds from vaccine manufacturers. At the same

00:20:46.010 --> 00:20:50.929
time, he sat on government committees to help
determine vaccine policy and efficacy.

00:20:50.929 --> 00:20:57.929
FARYON: A cynic might say that if you have
a community of experts in pertussis as in

00:20:59.330 --> 00:21:04.970
the Global Pertussis Initiative, who primarily
their work in terms of this endeavor is being

00:21:04.970 --> 00:21:10.250
funded by the drug company that makes the
vaccine, there might be less incentive to

00:21:10.250 --> 00:21:16.179
say make a new vaccine and more incentive
to say just use the old one more often. What

00:21:16.179 --> 00:21:17.830
do you say to them?

00:21:17.830 --> 00:21:24.830
CHERRY: I donít think thatís true. I think
that weíve been talking about new vaccines.

00:21:25.270 --> 00:21:32.270
It think the difficulty with the new vaccine
lies in the expense that it would cost to

00:21:33.480 --> 00:21:40.480
make a new vaccine and the difficulty in testing
it and FDA requirements for it and I think

00:21:46.110 --> 00:21:52.380
if the climate was right for two of the major
manufacturers they would do it.

00:21:52.380 --> 00:21:55.429
MOOI: And these are three different pertussis
strains.

00:21:55.429 --> 00:21:59.010
FARYON: Dr. Mooi is a critic of the Pertussis
Initiative.

00:21:59.010 --> 00:22:06.010
MOOI: My big disappointment is they have totally
and I think willfully ignored pathogen adaptation.

00:22:09.250 --> 00:22:16.250
I think a few years ago we had the year that
Darwin died 100 year ago, it was not so long

00:22:20.760 --> 00:22:27.760
ago, I think it's very strange that evolution
and pathogen adaptation is completely ignored

00:22:29.210 --> 00:22:34.600
by such a group. I find that bad for science
and bad for public health.

00:22:34.600 --> 00:22:41.010
FARYON: Sanofi Pastuer released this statement
to KPBS and the Watchdog Institute. It says

00:22:41.010 --> 00:22:47.480
its grant to the GPI brings the world's authorities
on pertussis together and that benefits society

00:22:47.480 --> 00:22:53.100
as a whole. The company also says ìat the
present time, there is no evidence to suggest

00:22:53.100 --> 00:23:00.100
current pertussis vaccines lack effectiveness.î
Dr. Dean Sidelinger was one of the first health

00:23:00.309 --> 00:23:05.480
officials to learn immunized people were getting
sick in his county. He said he was surprised,

00:23:05.480 --> 00:23:11.429
but in the end, he says the current vaccine
is still the best thing heís got to protect

00:23:11.429 --> 00:23:12.029
his community.

00:23:12.029 --> 00:23:16.640
SIDELINGER: It does significantly decrease
the pertussis we see a significantly lower

00:23:16.640 --> 00:23:21.809
number of pertussis cases now then we saw
before we started using the vaccine. So we

00:23:21.809 --> 00:23:26.799
donít want people to feel complacent to say
I donít want that vaccine because Iíve seen

00:23:26.799 --> 00:23:29.620
many of the cases that have been reported
were fully vaccinated.

00:23:29.620 --> 00:23:34.760
FARYON: Sidelinger says there would be many
more cases if there was no vaccine at all.

00:23:34.760 --> 00:23:40.230
Dr. Mooi agrees. He believes public health
officials should be encouraging cocooning,

00:23:40.230 --> 00:23:46.070
immunizing all those around newborn babies.
But in the long run, he says we need better

00:23:46.070 --> 00:23:53.070
vaccines. Baby Matthew spent four days in
the hospital and was eventually discharged.

00:23:54.320 --> 00:23:57.230
Today, heís getting his two-month routine
check-up.

00:23:57.230 --> 00:24:01.070
DOCTOR: I think it was just back luck heís
had two illnesses in a row and now the cold

00:24:01.070 --> 00:24:03.860
he's building up his immunity.

00:24:03.860 --> 00:24:08.940
FARYON: Despite a stuffy nose, Matthew is
doing well today.

00:24:08.940 --> 00:24:13.980
DCOTOR: As you might know the vaccine is not
as effective as we want it to be. And that's

00:24:13.980 --> 00:24:19.600
one reason why there've been a lot of cases.
But with Matthew in particular, his own immunity

00:24:19.600 --> 00:24:26.210
has kicked in from having the illness, that
is, in effect a sort of a booster that will

00:24:26.210 --> 00:24:31.299
protect him going forward. And how long that
immunity lasts is still a question.

00:24:31.299 --> 00:24:38.299
MARLON: The one thing I would want to say
to parents is just watch your kids,
just be concerned. Because at first we thought

00:24:48.899 --> 00:24:55.899
we were being over protective. But Iím glad
we were just a little bit over-concerned.

00:24:57.529 --> 00:25:03.350
FARYON: Since KPBS and the Watchdog Institute
began its investigation, state health officials,

00:25:03.350 --> 00:25:10.350
the CDC and scientists from UCLA, including
Dr. James Cherry, began a new study to determine

00:25:10.500 --> 00:25:16.169
whether the new strain of pertussis is contributing
to the current whooping cough outbreak. For

00:25:16.169 --> 00:25:20.490
more on this story, and to see more of the
data collected in our investigation, go to

00:25:20.490 --> 00:25:27.490
kpbs.org/whoopingcough and watchdoginstitute.org.
For KPBS, the Watchdog Institute and Radio

00:25:30.919 --> 00:25:34.480
Netherlands Worldwide, Iím Joanne Faryon.
Thanks for watching.