0:00:09.625,0:00:12.220 JOANNE FARYON: Hello, I'm Joanne Faryon. 0:00:12.220,0:00:15.610 Welcome to tonight's special, When Immunity Fails: 0:00:15.610,0:00:17.790 The Whooping Cough Epidemic. 0:00:17.790,0:00:21.560 We'll explore the worst whooping cough outbreak in California 0:00:21.560,0:00:23.510 in more than 60 years. 0:00:23.510,0:00:26.890 Just why is a disease that was nearly extinct thirty years ago, 0:00:26.890,0:00:30.920 finding its way back not just in this state, but in other parts 0:00:30.920,0:00:32.460 of the country as well? 0:00:32.460,0:00:34.780 What we learned may surprise you. 0:00:34.780,0:00:37.640 There are serious questions about how well the vaccine 0:00:37.640,0:00:39.900 to prevent the disease works; 0:00:39.900,0:00:42.310 questions government health officials have been slow 0:00:42.310,0:00:44.130 to even ask. 0:00:44.130,0:00:47.220 KPBS teamed up with the Watchdog Institute, 0:00:47.220,0:00:48.960 an investigative journalism center 0:00:48.960,0:00:51.230 at San Diego State University, 0:00:51.230,0:00:54.450 and Radio Netherlands Worldwide to tell this story. 0:00:54.450,0:00:57.000 A story that took us across California 0:00:57.000,0:00:59.630 and overseas to Amsterdam. 0:00:59.630,0:01:02.370 But first, we begin in a delivery room 0:01:02.370,0:01:06.610 in a San Diego hospital, where a mother has just given birth 0:01:06.610,0:01:08.309 to her third son. 0:01:08.309,0:01:15.141 [ baby crying ] 0:01:15.141,0:01:19.190 Matthew Jacob Bryce was born Oct 11, 2010. 0:01:19.190,0:01:23.710 A healthy baby, the third boy for Cindy and Marlon Bryce. 0:01:23.710,0:01:25.770 Matthew started showing signs of a cold 0:01:25.770,0:01:27.450 when he was just two weeks old. 0:01:27.450,0:01:29.730 The Bryce family knew something was wrong. 0:01:29.730,0:01:31.340 MARLON BRYCE: It just seemed 0:01:31.340,0:01:35.640 like this cold it was just affecting his breathing. 0:01:35.640,0:01:38.710 FARYON: The family was aware of the whooping cough epidemic 0:01:38.710,0:01:40.540 in California, from news reports REPORTER: 0:01:40.540,0:01:43.130 State health officials say more than 6,400 cases 0:01:43.130,0:01:44.920 of whooping cough have been reported this year. 0:01:44.920,0:01:46.710 FARYON: And their pediatrician. 0:01:46.710,0:01:48.300 BRYCE: There wasn't any whooping 0:01:48.300,0:01:52.520 or they always say there is a whooping or a cough, 0:01:52.520,0:01:54.480 he didn't have a cough or anything it was just 0:01:54.480,0:01:55.430 that there was a cold. 0:01:55.430,0:01:58.620 FARYON: Matthew's doctor suspected it could be whooping 0:01:58.620,0:02:00.810 cough, also known as Pertussis. 0:02:00.810,0:02:03.670 She took a nasal swab and sent it to the lab. 0:02:03.670,0:02:06.500 She also started Matthew on antibiotics. 0:02:06.500,0:02:09.970 Six days later, with Matthew just 23 days old, 0:02:09.970,0:02:11.370 Cindy Bryce got a phone call 0:02:11.370,0:02:13.480 from the California Department of Health. 0:02:13.480,0:02:15.930 The diagnosis was whooping cough. 0:02:15.930,0:02:20.860 M. BRYCE: The moment I heard it I just immediately started 0:02:20.860,0:02:26.050 thinking the worst because you have heard the news 0:02:26.050,0:02:28.690 about the babies that have passed away. 0:02:28.690,0:02:31.770 FARYON: From January to October this year, 0:02:31.770,0:02:35.060 10 newborns in California died from whooping cough, 0:02:35.060,0:02:37.160 two in San Diego County. 0:02:37.160,0:02:40.450 More than 7,000 children and adults got sick 0:02:40.450,0:02:43.370 from the disease - the highest number in the state 0:02:43.370,0:02:45.200 in more than 60 years. 0:02:45.200,0:02:48.880 Just how did Matthew and so many others come down with a disease 0:02:48.880,0:02:51.960 that is supposed to be preventable with a vaccine? 0:02:51.960,0:02:53.970 Tonight we'll raise questions 0:02:53.970,0:02:56.910 about the effectiveness of that vaccine. 0:02:56.910,0:03:01.410 A four-month investigation by KPBS and the Watchdog Institute, 0:03:01.410,0:03:03.860 found many people who have been diagnosed 0:03:03.860,0:03:07.140 with whooping cough were immunized. 0:03:07.140,0:03:09.910 We also show how government data on the number 0:03:09.910,0:03:13.350 of people diagnosed with whooping cough lacks timeliness 0:03:13.350,0:03:16.680 and is often inconsistent, begging the question: 0:03:16.680,0:03:19.590 just who is keeping track of this epidemic? 0:03:19.590,0:03:21.650 We'll show you how some of the experts 0:03:21.650,0:03:25.210 who influence vaccine policy are financially tied 0:03:25.210,0:03:27.040 to vaccine companies. 0:03:27.040,0:03:29.390 And, we'll follow the Bryce family as they struggle 0:03:29.390,0:03:33.828 with their son's diagnosis, and the setbacks in his recovery. 0:03:36.921,0:03:40.640 Whooping cough, violent cough, the hundred-day cough; 0:03:40.640,0:03:42.370 all names for Pertussis. 0:03:42.370,0:03:44.920 DR. JAMES CHERRY: What causes the cough actually we 0:03:44.920,0:03:45.690 don't know... 0:03:45.690,0:03:47.450 there's no other cough quite like it. 0:03:47.450,0:03:50.840 FARYON: Pertussis is a respiratory illness caused 0:03:50.840,0:03:53.430 by the bacterium Bordetella pertussis. 0:03:53.430,0:03:55.530 At first, it can mimic a cold. 0:03:55.530,0:03:59.070 But later produces a violent and persistent cough, 0:03:59.070,0:04:02.090 a cough that leaves children gasping for air - 0:04:02.090,0:04:05.200 creating the distinct whooping sound. 0:04:05.200,0:04:08.380 For adults, whooping cough may only be a nuisance. 0:04:08.380,0:04:11.260 In fact scientists estimate more than 80 percent 0:04:11.260,0:04:14.130 of adult cases are never diagnosed 0:04:14.130,0:04:17.260 because most people assume they just have a bad cold. 0:04:17.260,0:04:20.500 But to infants whooping cough can be deadly, 0:04:20.500,0:04:22.950 especially if not diagnosed early. 0:04:22.950,0:04:25.390 DR. JAMES CHERRY: So with infection 0:04:25.390,0:04:29.850 that you eventually clear the bacteria and you get better. 0:04:29.850,0:04:34.474 But it's a prolonged, most cases ... 0:04:34.474,0:04:37.363 a good percentage of cases in children 0:04:37.363,0:04:39.622 will last for one or two months. 0:04:39.622,0:04:41.686 DR. FRITS MOOI: After a pertussis infection 0:04:41.686,0:04:45.039 you often get super infections, actually that is one 0:04:45.039,0:04:47.090 of the main complications, pneumonia. 0:04:47.090,0:04:50.240 FARYON: Young babies aren't able to cough up secretions 0:04:50.240,0:04:52.610 that collect in their lungs, leading to pneumonia 0:04:52.610,0:04:54.930 and making it difficult to breathe. 0:04:54.930,0:04:59.490 Early antibiotic treatment is most critical in this age group. 0:04:59.490,0:05:02.630 Whooping cough was nearly wiped out by the late 1970's 0:05:02.630,0:05:04.910 because of mass immunization, 0:05:04.910,0:05:07.400 but it's somehow found its way back to California 0:05:07.400,0:05:11.290 and other highly vaccinated communities around the world. 0:05:11.290,0:05:14.070 Just why it's made such a vengeful comeback has two 0:05:14.070,0:05:17.580 of the world's leading whooping cough experts in disagreement. 0:05:17.580,0:05:20.270 Dr. James Cherry of UCLA: CHERRY: 0:05:20.270,0:05:22.530 The main reason is increased awareness. 0:05:22.530,0:05:25.120 FARYON: and Dr. Frits Mooi of the Netherlands Centre 0:05:25.120,0:05:26.950 for Infectious Diseases Control. 0:05:26.950,0:05:33.350 MOOI: We found really a new mutation in the bug. 0:05:33.350,0:05:37.120 FARYON: Dr. Mooi and Dr. Cherry both began their research 0:05:37.120,0:05:39.750 into Whooping Cough about 30 years ago. 0:05:39.750,0:05:42.940 Cherry in the U.S. and Mooi in The Netherlands. 0:05:42.940,0:05:45.620 The two scientists know each other's work. 0:05:45.620,0:05:49.790 CHERRY: First of all, his molecular microbiological science is, 0:05:49.790,0:05:54.990 he's right at the top of scholars. 0:05:54.990,0:05:57.370 There's no question about that. 0:05:57.370,0:06:02.150 I think where some of the things he's published is the clinical 0:06:02.150,0:06:04.060 data are not very good. 0:06:04.060,0:06:07.290 MOOI: I don't communicate too much with him but what he wrote 0:06:07.290,0:06:11.590 in the press is that I screw up epidemiology. 0:06:11.590,0:06:13.440 That doesn't help me too much. 0:06:13.440,0:06:16.490 FARYON: To understand why these two experts disagree, 0:06:16.490,0:06:18.570 you need to know a little about the history 0:06:18.570,0:06:19.850 of the pertussis vaccine. 0:06:19.850,0:06:23.710 ANNOUNCER: Since most serious cases occur before school age, 0:06:23.710,0:06:26.120 immunization in school may be too late. 0:06:26.120,0:06:29.340 FARYON: The bacteria that causes whooping cough was first 0:06:29.340,0:06:32.100 isolated in Belgium in 1906. 0:06:32.100,0:06:33.850 At the time, the illness was one 0:06:33.850,0:06:35.700 of the leading causes of infant death. 0:06:35.700,0:06:40.680 ANNOUNCER: In 1921, whooping cough killed 316 0:06:40.680,0:06:42.560 Michigan children. 0:06:42.560,0:06:47.310 Last year, the number of deaths was reduced to 63. 0:06:47.310,0:06:51.340 FARYON: The discovery lead to the first attempts at a vaccine. 0:06:51.340,0:06:55.250 But it wasn't until the late 1940's scientists developed a 0:06:55.250,0:06:58.010 vaccine effective enough to prevent whooping cough. 0:06:58.010,0:06:59.920 ANNOUNCER: Unlike the disease however, 0:06:59.920,0:07:01.670 a vaccine does not endanger life. 0:07:01.670,0:07:05.350 FARYON: By 1946, mass immunization programs began 0:07:05.350,0:07:08.850 in the U.S. and the number of cases dropped dramatically. 0:07:08.850,0:07:10.790 Prior to the vaccine the rate 0:07:10.790,0:07:14.800 of disease was 157 cases per 100,000. 0:07:14.800,0:07:19.810 By the 1970's, with large scale immunizations, fewer than one 0:07:19.810,0:07:22.670 in one hundred thousand people got whooping cough. 0:07:22.670,0:07:26.220 But the vaccine was not without controversy. 0:07:26.220,0:07:29.340 The early versions were associated with side effects 0:07:29.340,0:07:32.970 such as prolonged crying spells and seizures in babies. 0:07:32.970,0:07:37.630 By 1996, the FDA approved a new whooping cough vaccine. 0:07:37.630,0:07:40.170 It was called an acellular version. 0:07:40.170,0:07:43.270 That means the vaccine uses only purified components 0:07:43.270,0:07:45.620 of the disease-causing organism. 0:07:45.620,0:07:49.080 That vaccine was considered to be safer and associated 0:07:49.080,0:07:51.320 with few mild side effects. 0:07:51.320,0:07:56.508 Today, the U.S. uses only the acellular pertussis vaccine. 0:07:59.408,0:08:02.617 But as the United States was changing vaccines something else 0:08:02.617,0:08:04.419 was happening 0:08:05.788,0:08:09.740 health officials across the country were reporting increasing numbers 0:08:09.740,0:08:12.160 of positive whooping cough cases. 0:08:12.160,0:08:16.140 And in a government lab about 30 minutes outside of Amsterdam, 0:08:16.140,0:08:19.190 a group of scientists had discovered something else - 0:08:19.190,0:08:22.320 the bacterium that causes whooping cough started 0:08:22.320,0:08:23.990 to look a little different. 0:08:23.990,0:08:28.690 MOOI: This new mutation had the effect that the bacteria started 0:08:28.690,0:08:30.520 to produce more pertussis toxin. 0:08:30.520,0:08:32.800 FARYON: Just whether that mutation is to blame, 0:08:32.800,0:08:35.490 at least in part, for the California epidemic 0:08:35.490,0:08:38.350 and outbreaks elsewhere in the world is at the heart 0:08:38.350,0:08:40.260 of the whooping cough debate. 0:08:40.260,0:08:44.450 Dr. Mooi believes this to be the case, but not Dr. Cherry. 0:08:44.450,0:08:47.230 CHERRY: Even though these changes have occurred there is 0:08:47.230,0:08:51.110 no evidence that that's lead to increased vaccine failure. 0:08:56.240,0:08:59.670 FARYON: Here in San Diego County, more than 85 percent 0:08:59.670,0:09:01.400 of children are immunized. 0:09:01.400,0:09:03.190 In fact, less than three percent 0:09:03.190,0:09:06.860 of kids entering kindergarten have not been immunized 0:09:06.860,0:09:09.070 because of their family's personal beliefs. 0:09:09.070,0:09:11.770 But despite the high immunization rate, 0:09:11.770,0:09:14.510 San Diego has the second largest number 0:09:14.510,0:09:17.660 of positive whooping cough cases in California. 0:09:17.660,0:09:20.760 Dr. Dean Sidelinger is San Diego's deputy public 0:09:20.760,0:09:21.710 health officer. 0:09:21.710,0:09:22.710 DR. DEAN SIDELINGER: This is a disease 0:09:22.710,0:09:25.150 that if someone has it it's very easily transferred 0:09:25.150,0:09:26.770 from one person to another. 0:09:26.770,0:09:29.100 So if you or I sitting here during this interview, 0:09:29.100,0:09:32.090 one of us had pertussis chances are we could transmit 0:09:32.090,0:09:33.470 that to the other person. 0:09:33.470,0:09:34.990 Sidelinger says in the past, 0:09:34.990,0:09:37.990 the number of whooping cough cases peaked in summer 0:09:37.990,0:09:41.690 and slowed by fall, but this year, that didn't happen. 0:09:41.690,0:09:45.350 SIDELINGER: So as time goes on we're seeing more cases. 0:09:45.350,0:09:48.950 We know that public awareness plays into that as we talk 0:09:48.950,0:09:51.480 about Pertussis more people are asking their doctors 0:09:51.480,0:09:53.230 and doctors are asking their patients we're going 0:09:53.230,0:09:55.410 to see more, but that trend continued. 0:09:55.410,0:09:59.530 FARYON: By the end of November 2010, nearly 1000 infants, 0:09:59.530,0:10:02.830 children and adults in San Diego County tested positive 0:10:02.830,0:10:04.050 for whooping cough. 0:10:04.050,0:10:06.760 More than half of them had been immunized. 0:10:06.760,0:10:08.090 Our investigation shows 0:10:08.090,0:10:10.890 that trend continues throughout California. 0:10:10.890,0:10:14.190 KPBS and The Watchdog Institute collected data 0:10:14.190,0:10:16.950 from 9 California counties that report some 0:10:16.950,0:10:19.050 of the highest infection rates. 0:10:19.050,0:10:22.590 Our research shows that where immunization history is known, 0:10:22.590,0:10:26.240 between 44 and 83 percent of people diagnosed 0:10:26.240,0:10:28.650 with whooping cough were vaccinated. 0:10:28.650,0:10:30.370 We looked at California Department 0:10:30.370,0:10:32.430 of Public Health records too. 0:10:32.430,0:10:35.460 In cases where vaccination history was recorded, 0:10:35.460,0:10:39.090 more than 80 percent of infected people had been immunized. 0:10:39.090,0:10:41.050 DR. MARK HORTON: From the epidemiology experts 0:10:41.050,0:10:45.780 and the experts in vaccine this is absolutely expected. 0:10:45.780,0:10:48.220 FARYON: Dr. Mark Horton is the director 0:10:48.220,0:10:50.740 of the California Department of Public Health. 0:10:50.740,0:10:52.560 HORTON: If you've got a percentage 0:10:52.560,0:10:56.340 of the population vaccinated and a percentage of those vaccinated 0:10:56.340,0:10:57.440 that are still susceptible 0:10:57.440,0:11:00.820 because the vaccine isn't perfectly effective or effective 0:11:00.820,0:11:02.800 in all individuals, when you work 0:11:02.800,0:11:05.050 out the arithmetic you'll see that even 0:11:05.050,0:11:06.980 with a very effective vaccine, 0:11:06.980,0:11:08.360 and even if you have the majority 0:11:08.360,0:11:10.300 of the population vaccinated, 0:11:10.300,0:11:14.130 the pool of susceptibles will include a number of individuals 0:11:14.130,0:11:15.390 that have never been vaccinated 0:11:15.390,0:11:19.390 but will also include quite a few and in some cases greater 0:11:19.390,0:11:20.240 than 50 percent 0:11:20.240,0:11:22.350 of the individuals have been previously vaccinated. 0:11:22.350,0:11:24.670 FARYON: In other words, if you do the math, 0:11:24.670,0:11:26.720 you will always find a certain number 0:11:26.720,0:11:28.620 of immunized people getting sick 0:11:28.620,0:11:31.650 if a vaccine is not 100 percent effective. 0:11:31.650,0:11:34.930 HORTON: So that's no surprise to us nor is it a reflection 0:11:34.930,0:11:36.520 on the efficacy of the vaccine. 0:11:36.520,0:11:37.890 REPORTER KEVIN CROWE: It's not a reflection 0:11:37.890,0:11:39.070 on the efficacy of the vaccine? 0:11:39.070,0:11:39.690 HORTON: Correct, correct. 0:11:39.690,0:11:42.560 FARYON: But 20 years ago, the reverse was true. 0:11:42.560,0:11:44.990 According to a report by the Centers for Disease Control, 0:11:44.990,0:11:48.420 more than half of the children between 3 months and 4 years old 0:11:48.420,0:11:51.450 who got whooping cough nationwide between 1990 0:11:51.450,0:11:53.900 and 1996 were not immunized. 0:11:53.900,0:11:56.480 The rate of whooping cough has also been increasing 0:11:56.480,0:11:58.050 for the past 20 years. 0:11:58.050,0:12:00.900 From less than one in 100,000 0:12:00.900,0:12:04.250 to 18 per 100,000 here in California. 0:12:04.250,0:12:08.580 And in some California counties such as San Luis Obispo, 0:12:08.580,0:12:12.880 rates are nearly as high as before vaccines were developed. 0:12:12.880,0:12:14.910 Two days after our interview 0:12:14.910,0:12:18.630 with the Bryce family, Matthew got a fever. 0:12:18.630,0:12:21.480 He was hospitalized at Rady's Children's Hospital 0:12:21.480,0:12:24.000 in San Diego. 0:12:24.000,0:12:26.820 Matthew was not immunized against whooping cough. 0:12:26.820,0:12:28.060 He's too young. 0:12:28.060,0:12:31.900 Babies can't be immunized until they're two months old. 0:12:31.900,0:12:34.880 But everyone else in the Bryce family was vaccinated - 0:12:34.880,0:12:37.160 even his parents got booster shots. 0:12:37.160,0:12:39.400 The practice of immunizing everyone 0:12:39.400,0:12:42.030 around a newborn baby is called cocooning. 0:12:42.030,0:12:46.860 CINDY BRYCE: When I called the doctor they asked me who has it 0:12:46.860,0:12:50.390 and I couldn't give them an answer because I don't know 0:12:50.390,0:12:53.460 where he got it from because everyone's been vaccinated. 0:12:53.460,0:12:56.550 FARYON: Myron and one of his sons were also tested 0:12:56.550,0:12:58.390 for whooping cough - both were negative. 0:12:58.390,0:13:00.990 M. BRYCE: The one thing I would want 0:13:00.990,0:13:05.740 to know is the vaccine working? 0:13:05.740,0:13:11.300 Is it as effective because before this I thought the 0:13:11.300,0:13:18.710 vaccine was working and I thought that if I did everything 0:13:18.710,0:13:27.220 that I was told to do that our sons would be protected. 0:13:27.220,0:13:30.140 FARYON: Just how effective is the vaccine? 0:13:30.140,0:13:32.700 That all depends on who you talk to. 0:13:32.700,0:13:34.250 Drug information included 0:13:34.250,0:13:37.110 with the two most commonly used whooping cough vaccines 0:13:37.110,0:13:40.410 in the US say the vaccine is 85 percent effective. 0:13:40.410,0:13:44.120 MOOI: This new strain has completely invaded the 0:13:44.120,0:13:46.490 Netherlands and also other countries and pushed 0:13:46.490,0:13:48.290 out all the other strains. 0:13:48.290,0:13:49.090 It's quite unique. 0:13:49.090,0:13:51.660 FARYON: Dr. Mooi believes there's no way 0:13:51.660,0:13:54.480 to determine how effective the vaccines are 0:13:54.480,0:13:56.130 because they have not been tested 0:13:56.130,0:13:58.390 against the new strain of whooping cough. 0:13:58.390,0:13:59.740 MOOI: We call it the p3 strain. 0:13:59.740,0:14:02.550 FARYON: A strain he believes is more virulent 0:14:02.550,0:14:04.000 and can make people sicker. 0:14:04.000,0:14:07.540 This strain emerged while the new acellular vaccines were 0:14:07.540,0:14:08.380 being developed. 0:14:08.380,0:14:09.510 MOOI: I can tell you one 0:14:09.510,0:14:14.320 of the reasons the vaccine companies are not too happy 0:14:14.320,0:14:20.750 with me is because if what I say is true they selected the wrong 0:14:20.750,0:14:22.980 strains in the 1980's. 0:14:22.980,0:14:25.440 FARYON: Mooi's lab was studying the new strain 0:14:25.440,0:14:28.620 when The Netherlands experienced an unexpected whooping cough 0:14:28.620,0:14:30.270 epidemic in 1996. 0:14:31.058,0:14:33.147 MOOI: There was a very direct relationship 0:14:33.147,0:14:37.695 between the emergence of these strains, we call them p3 strains 0:14:37.695,0:14:40.640 and the increase in pertussis notifications. 0:14:40.640,0:14:44.820 CHERRY: There's absolutely no evidence that either 0:14:44.820,0:14:48.870 of the two vaccines that are most common today used 0:14:48.870,0:14:54.330 in the U.S. that there is increased vaccine failure 0:14:54.330,0:14:56.020 with either of those vaccines. 0:14:56.020,0:15:01.130 FARYON: So if you had to explain why we're seeing this epidemic 0:15:01.130,0:15:03.080 the highest number of cases in 60 years, 0:15:03.080,0:15:04.690 what would you tell people? 0:15:04.690,0:15:07.560 CHERRY: The main reason is increased awareness. 0:15:07.560,0:15:12.500 People, particularly public health people are much more 0:15:12.500,0:15:14.890 aware and that trickles down. 0:15:14.890,0:15:17.560 FARYON: Cherry says the increase is also due in part 0:15:17.560,0:15:19.890 because of something called waning immunity. 0:15:19.890,0:15:23.500 Immunity to whooping cough does not last a lifetime, 0:15:23.500,0:15:26.440 whether you are vaccinated or develop natural immunity 0:15:26.440,0:15:27.960 from getting the disease. 0:15:27.960,0:15:31.590 Almost all experts agree waning immunity is contributing 0:15:31.590,0:15:34.350 to whooping cough outbreaks worldwide. 0:15:34.350,0:15:38.574 Where they disagree: when does immunity fail? 0:15:41.066,0:15:45.300 Dr. Mooi believes the new strain of Pertussis causes immunity 0:15:45.300,0:15:47.400 to fail sooner than in the past. 0:15:47.400,0:15:49.180 And he's published his findings 0:15:49.180,0:15:52.510 in several peer reviewed journals including the CDC's 0:15:52.510,0:15:54.010 Infectious Diseases. 0:15:54.010,0:15:59.280 MOOI: When the immunity is sub-optimal what will happen the 0:15:59.280,0:16:04.300 bacteria will not be recognized very well by the immune system 0:16:04.300,0:16:08.330 because of the mismatch and second of all even 0:16:08.330,0:16:10.710 if immune response is started 0:16:10.710,0:16:14.740 in the body the toxin will be able to delay it. 0:16:14.740,0:16:19.920 You could say these two changes work together 0:16:19.920,0:16:22.460 by decreasing the period 0:16:22.460,0:16:25.830 of which the vaccine is protective further. 0:16:25.830,0:16:27.900 FARYON: The Netherlands learned something else 0:16:27.900,0:16:30.350 after its 1996 epidemic. 0:16:30.350,0:16:33.320 At the time, it had very few samples of the bacteria 0:16:33.320,0:16:35.850 that was causing people to get sick. 0:16:35.850,0:16:38.790 So Mooi's lab began asking doctors and their labs 0:16:38.790,0:16:41.460 to send him positive Pertussis swabs. 0:16:41.460,0:16:44.700 His lab now has 3,000 samples. 0:16:44.700,0:16:47.920 California has collected just 29 samples from the more 0:16:47.920,0:16:51.550 than 7,000 whooping cough cases in the state. 0:16:51.550,0:16:55.080 During the KPBS/Watchdog four month investigation, 0:16:55.080,0:16:57.170 we also learned data kept by the state 0:16:57.170,0:17:00.890 and the CDC was often lagging behind county data 0:17:00.890,0:17:02.700 and was inconsistent. 0:17:02.700,0:17:05.860 While counties like San Diego knew the immunization status 0:17:05.860,0:17:08.540 of the vast majority of people with whooping cough, 0:17:08.540,0:17:11.770 the state's data listed the information as unknown. 0:17:11.770,0:17:15.180 Despite statewide protocols for reporting pertussis, 0:17:15.180,0:17:19.230 a KPBS/Watchdog survey found some counties don't follow them 0:17:19.230,0:17:22.140 or are slow to report the information HORTON: 0:17:22.140,0:17:24.930 There's a perception that the more numbers the better, 0:17:24.930,0:17:30.460 but let me be very clear we in no way need reports 0:17:30.460,0:17:33.050 on every single case of pertussis for us 0:17:33.050,0:17:37.040 to make important judgments and decisions 0:17:37.040,0:17:38.330 about what's happening. 0:17:38.330,0:17:41.490 FARYON: The CDC in Atlanta declined our requests 0:17:41.490,0:17:42.570 for an interview. 0:17:42.570,0:17:45.480 In an email response they said it is "difficult 0:17:45.480,0:17:49.380 to disentangle all the factors" contributing to increases 0:17:49.380,0:17:52.870 in pertussis, but listed "increasing transmission, 0:17:52.870,0:17:54.360 better recognition, 0:17:54.360,0:17:57.300 and increased laboratory confirmation." 0:17:57.300,0:18:00.300 We also asked whether a new more virulent strain could be 0:18:00.300,0:18:02.060 contributing to the outbreak. 0:18:02.060,0:18:05.790 The CDC's response: "Available data do not suggest 0:18:05.790,0:18:08.350 that ptxP3 is more virulent, 0:18:08.350,0:18:11.420 or that increasing reports are attributable only 0:18:11.420,0:18:14.270 to the emergence of ptxP3. 0:18:14.270,0:18:18.360 We continue to work on this and other potential explanations 0:18:18.360,0:18:20.460 for the increase in pertussis 0:18:20.460,0:18:23.780 that has occurred since the 1980s." 0:18:23.780,0:18:26.940 The CDC sent us this study by their own investigators. 0:18:26.940,0:18:28.180 The study looked at children 0:18:28.180,0:18:30.950 between 6 months and five years old. 0:18:30.950,0:18:33.080 It found pertussis vaccines to be more 0:18:33.080,0:18:35.240 than 90 percent effective. 0:18:35.240,0:18:39.600 The study looked at data between 1998 and 2001. 0:18:39.600,0:18:42.710 It did not collect pertussis strain information. 0:18:42.710,0:18:46.850 SINGING: Do you happen to know what a T-dap is? 0:18:46.850,0:18:51.829 It's a special vaccine but it's not just for kids. 0:18:53.260,0:18:55.940 FARYON: Sanofi Pastuer, one of two companies 0:18:55.940,0:18:59.360 that make the vaccine widely used in the U.S., 0:18:59.360,0:19:02.330 sponsored this singing competition earlier this year. 0:19:02.330,0:19:07.070 SINGING: Pertussis is the reason why you should call your 0:19:07.070,0:19:09.010 doctor today. 0:19:09.010,0:19:11.410 FARYON: It was a public relations exercise 0:19:11.410,0:19:15.040 to get the word out about whooping cough and immunization. 0:19:15.040,0:19:18.320 But just where is the line between good PR and trying 0:19:18.320,0:19:20.750 to influence public health policy? 0:19:20.750,0:19:23.990 SINGING: Take a shot and give pertussis a whooping. 0:19:23.990,0:19:28.700 FARYON: Especially when public health policy can increase 0:19:28.700,0:19:30.140 vaccine sales. 0:19:30.140,0:19:33.040 Since 2007, the California department 0:19:33.040,0:19:36.030 of health has spent more than $200 million 0:19:36.030,0:19:39.430 on pertussis vaccines for children on medical 0:19:39.430,0:19:41.060 or who are under-insured. 0:19:41.060,0:19:43.510 And it's sure to rise. 0:19:43.510,0:19:47.840 In September, the California state legislature passed a law 0:19:47.840,0:19:50.810 requiring all students to receive another dose, 0:19:50.810,0:19:54.200 a sixth dose of the pertussis vaccine before entering 0:19:54.200,0:19:55.360 middle school. 0:19:55.360,0:19:57.110 It may be a case of what's good 0:19:57.110,0:19:59.850 for business is also good for public health. 0:19:59.850,0:20:02.340 But how much influence does industry have 0:20:02.340,0:20:04.150 over public health policy? 0:20:04.150,0:20:06.470 Sanofi Pasteur also established 0:20:06.470,0:20:09.390 and funds The Global Pertussis Initiative. 0:20:09.390,0:20:13.340 A group made up of medical experts from around the world. 0:20:13.340,0:20:15.720 The GPI was established 10 years ago 0:20:15.720,0:20:19.980 to study why pertussis was making a comeback and find ways 0:20:19.980,0:20:21.550 to control the disease. 0:20:21.550,0:20:23.340 More than half its members are employees 0:20:23.340,0:20:25.050 of the pharmaceutical company 0:20:25.050,0:20:28.170 or receive research money or consulting fees. 0:20:28.170,0:20:31.460 Public officials from across the country, including California 0:20:31.460,0:20:34.880 and the CDC, site the Global Pertussis Initiative 0:20:34.880,0:20:37.210 when making vaccine policy. 0:20:37.210,0:20:40.140 Dr. James Cherry is a member of the initiative. 0:20:40.140,0:20:43.240 He's also received speaking fees and research funds 0:20:43.240,0:20:45.320 from vaccine manufacturers. 0:20:45.320,0:20:48.080 At the same time, he sat on government committees 0:20:48.080,0:20:51.420 to help determine vaccine policy and efficacy. 0:20:51.420,0:20:56.450 FARYON: A cynic might say that if you have a community 0:20:56.450,0:21:01.260 of experts in pertussis as in the Global Pertussis Initiative, 0:21:01.260,0:21:03.940 who primarily their work in terms 0:21:03.940,0:21:06.370 of this endeavor is being funded by the drug company 0:21:06.370,0:21:10.120 that makes the vaccine, there might be less incentive 0:21:10.120,0:21:13.810 to say make a new vaccine and more incentive 0:21:13.810,0:21:16.410 to say just use the old one more often. 0:21:16.410,0:21:17.840 What do you say to them? 0:21:17.840,0:21:19.920 CHERRY: I don't think that's true. 0:21:19.920,0:21:25.500 I think that we've been talking about new vaccines. 0:21:25.500,0:21:32.490 It think the difficulty with the new vaccine lies in the expense 0:21:32.490,0:21:39.420 that it would cost to make a new vaccine and the difficulty 0:21:39.420,0:21:46.040 in testing it because of FDA requirements for it and I think 0:21:46.040,0:21:48.880 if the climate was right for either of two 0:21:48.880,0:21:52.270 of the major manufacturers they would do it. 0:21:52.270,0:21:55.480 MOOI: And these are three different pertussis strains. 0:21:55.480,0:21:59.220 FARYON: Dr. Mooi is a critic of the Pertussis Initiative. 0:21:59.220,0:22:04.630 MOOI: My big disappointment is they have totally 0:22:04.630,0:22:09.090 and I think willfully ignored pathogen adaptation. 0:22:09.090,0:22:15.500 I think a few years ago we had the year 0:22:15.500,0:22:21.110 that Darwin died 100 year ago, it was not so long ago, 0:22:21.110,0:22:25.460 I think it's very strange that evolution 0:22:25.460,0:22:29.180 and pathogen adaptation is completely ignored 0:22:29.180,0:22:30.200 by such a group. 0:22:30.200,0:22:35.060 I find that bad for science and bad for public health. 0:22:35.060,0:22:38.140 FARYON: Sanofi Pasteur released this statement to KPBS 0:22:38.140,0:22:40.310 and the Watchdog Institute. 0:22:40.310,0:22:44.150 It says its grant to the GPI brings the world's authorities 0:22:44.150,0:22:48.500 on pertussis together and that benefits society as a whole. 0:22:48.500,0:22:50.930 The company also says "at the present time, 0:22:50.930,0:22:54.860 there is no evidence to suggest current pertussis vaccines 0:22:54.860,0:22:56.800 lack effectiveness." 0:22:56.800,0:23:00.640 Dr. Dean Sidelinger was one of the first health officials 0:23:00.640,0:23:03.770 to learn immunized people were getting sick in his county. 0:23:03.770,0:23:06.780 He said he was surprised, but in the end, 0:23:06.780,0:23:10.760 he says the current vaccine is still the best thing he's got 0:23:10.760,0:23:12.280 to protect his community. 0:23:12.280,0:23:14.090 SIDELINGER: It does significantly decrease the 0:23:14.090,0:23:17.010 pertussis we see a significantly lower number 0:23:17.010,0:23:20.190 of pertussis cases now then we saw before we started using 0:23:20.190,0:23:21.280 the vaccine. 0:23:21.280,0:23:25.050 So we don't want people to feel complacent or to say I don't want 0:23:25.050,0:23:27.340 that vaccine because I've seen many of the cases 0:23:27.340,0:23:29.810 that have been reported were fully vaccinated. 0:23:29.810,0:23:32.430 FARYON: Sidelinger says there would be many more cases 0:23:32.430,0:23:34.700 if there was no vaccine at all. 0:23:34.700,0:23:36.040 Dr. Mooi agrees. 0:23:36.040,0:23:38.960 He believes public health officials should be encouraging 0:23:38.960,0:23:43.500 cocooning, immunizing all those around newborn babies. 0:23:43.500,0:23:48.940 But in the long run he says, we need better vaccines. 0:23:48.940,0:23:51.800 Baby Matthew spent four days in the hospital 0:23:51.800,0:23:54.250 and was eventually discharged. 0:23:54.250,0:23:57.400 Today, he's getting his two-month routine check-up. 0:23:57.400,0:24:00.100 DOCTOR: I think it was just bad luck he's had two illnesses 0:24:00.100,0:24:04.500 in a row and now the cold he's building up his immunity. 0:24:04.500,0:24:08.160 FARYON: Despite a stuffy nose, Matthew is doing well today. 0:24:08.160,0:24:11.270 DCOTOR: As you might know the vaccine is not 0:24:11.270,0:24:13.160 as effective as we want it to be. 0:24:13.160,0:24:17.210 And that's one reason why there've been a lot of cases going around. 0:24:17.210,0:24:21.527 But with Matthew in particular, his own immunity has kicked in 0:24:21.527,0:24:24.690 from having the illness, that is, in effect a sort 0:24:24.690,0:24:27.520 of a booster that will protect him going forward. 0:24:27.520,0:24:31.325 And how long that immunity lasts is still a question. 0:24:31.710,0:24:34.938 MARLON: The one thing I would want to say to parents is just ... 0:24:36.569,0:24:39.347 is just watch your kids ... 0:24:39.408,0:24:40.770 just be ... 0:24:45.000,0:24:47.389 just be concerned. 0:24:47.389,0:24:50.700 Because at first we thought we were being over protective. 0:24:51.623,0:24:57.360 But I'm glad we were just a little bit over-concerned. 0:24:57.360,0:25:00.910 FARYON: Since KPBS and the Watchdog Institute began its 0:25:00.910,0:25:04.540 investigation, state health officials, the CDC 0:25:04.540,0:25:08.160 and scientists from UCLA, including Dr. James Cherry, 0:25:08.160,0:25:11.590 began a new study to determine whether the new strain 0:25:11.590,0:25:13.450 of pertussis is contributing 0:25:13.450,0:25:15.990 to the current whooping cough outbreak. 0:25:15.990,0:25:18.610 For more on this story, and to see more of the data collected 0:25:18.610,0:25:24.370 in our investigation, go to kpbs.org/whoopingcough 0:25:24.370,0:25:27.760 and watchdoginstitute.org. 0:25:27.760,0:25:30.210 For KPBS, the Watchdog Institute 0:25:30.210,0:25:33.410 and Radio Netherlands Worldwide, I'm Joanne Faryon. 0:25:33.410,0:25:35.912 Thanks for watching.