1 00:00:09,625 --> 00:00:12,220 JOANNE FARYON: Hello, I'm Joanne Faryon. 2 00:00:12,220 --> 00:00:15,610 Welcome to tonight's special, When Immunity Fails: 3 00:00:15,610 --> 00:00:17,790 The Whooping Cough Epidemic. 4 00:00:17,790 --> 00:00:21,560 We'll explore the worst whooping cough outbreak in California 5 00:00:21,560 --> 00:00:23,510 in more than 60 years. 6 00:00:23,510 --> 00:00:26,890 Just why is a disease that was nearly extinct thirty years ago, 7 00:00:26,890 --> 00:00:30,920 finding its way back not just in this state, but in other parts 8 00:00:30,920 --> 00:00:32,460 of the country as well? 9 00:00:32,460 --> 00:00:34,780 What we learned may surprise you. 10 00:00:34,780 --> 00:00:37,640 There are serious questions about how well the vaccine 11 00:00:37,640 --> 00:00:39,900 to prevent the disease works; 12 00:00:39,900 --> 00:00:42,310 questions government health officials have been slow 13 00:00:42,310 --> 00:00:44,130 to even ask. 14 00:00:44,130 --> 00:00:47,220 KPBS teamed up with the Watchdog Institute, 15 00:00:47,220 --> 00:00:48,960 an investigative journalism center 16 00:00:48,960 --> 00:00:51,230 at San Diego State University, 17 00:00:51,230 --> 00:00:54,450 and Radio Netherlands Worldwide to tell this story. 18 00:00:54,450 --> 00:00:57,000 A story that took us across California 19 00:00:57,000 --> 00:00:59,630 and overseas to Amsterdam. 20 00:00:59,630 --> 00:01:02,370 But first, we begin in a delivery room 21 00:01:02,370 --> 00:01:06,610 in a San Diego hospital, where a mother has just given birth 22 00:01:06,610 --> 00:01:08,309 to her third son. 23 00:01:08,309 --> 00:01:15,141 [ baby crying ] 24 00:01:15,141 --> 00:01:19,190 Matthew Jacob Bryce was born Oct 11, 2010. 25 00:01:19,190 --> 00:01:23,710 A healthy baby, the third boy for Cindy and Marlon Bryce. 26 00:01:23,710 --> 00:01:25,770 Matthew started showing signs of a cold 27 00:01:25,770 --> 00:01:27,450 when he was just two weeks old. 28 00:01:27,450 --> 00:01:29,730 The Bryce family knew something was wrong. 29 00:01:29,730 --> 00:01:31,340 MARLON BRYCE: It just seemed 30 00:01:31,340 --> 00:01:35,640 like this cold it was just affecting his breathing. 31 00:01:35,640 --> 00:01:38,710 FARYON: The family was aware of the whooping cough epidemic 32 00:01:38,710 --> 00:01:40,540 in California, from news reports REPORTER: 33 00:01:40,540 --> 00:01:43,130 State health officials say more than 6,400 cases 34 00:01:43,130 --> 00:01:44,920 of whooping cough have been reported this year. 35 00:01:44,920 --> 00:01:46,710 FARYON: And their pediatrician. 36 00:01:46,710 --> 00:01:48,300 BRYCE: There wasn't any whooping 37 00:01:48,300 --> 00:01:52,520 or they always say there is a whooping or a cough, 38 00:01:52,520 --> 00:01:54,480 he didn't have a cough or anything it was just 39 00:01:54,480 --> 00:01:55,430 that there was a cold. 40 00:01:55,430 --> 00:01:58,620 FARYON: Matthew's doctor suspected it could be whooping 41 00:01:58,620 --> 00:02:00,810 cough, also known as Pertussis. 42 00:02:00,810 --> 00:02:03,670 She took a nasal swab and sent it to the lab. 43 00:02:03,670 --> 00:02:06,500 She also started Matthew on antibiotics. 44 00:02:06,500 --> 00:02:09,970 Six days later, with Matthew just 23 days old, 45 00:02:09,970 --> 00:02:11,370 Cindy Bryce got a phone call 46 00:02:11,370 --> 00:02:13,480 from the California Department of Health. 47 00:02:13,480 --> 00:02:15,930 The diagnosis was whooping cough. 48 00:02:15,930 --> 00:02:20,860 M. BRYCE: The moment I heard it I just immediately started 49 00:02:20,860 --> 00:02:26,050 thinking the worst because you have heard the news 50 00:02:26,050 --> 00:02:28,690 about the babies that have passed away. 51 00:02:28,690 --> 00:02:31,770 FARYON: From January to October this year, 52 00:02:31,770 --> 00:02:35,060 10 newborns in California died from whooping cough, 53 00:02:35,060 --> 00:02:37,160 two in San Diego County. 54 00:02:37,160 --> 00:02:40,450 More than 7,000 children and adults got sick 55 00:02:40,450 --> 00:02:43,370 from the disease - the highest number in the state 56 00:02:43,370 --> 00:02:45,200 in more than 60 years. 57 00:02:45,200 --> 00:02:48,880 Just how did Matthew and so many others come down with a disease 58 00:02:48,880 --> 00:02:51,960 that is supposed to be preventable with a vaccine? 59 00:02:51,960 --> 00:02:53,970 Tonight we'll raise questions 60 00:02:53,970 --> 00:02:56,910 about the effectiveness of that vaccine. 61 00:02:56,910 --> 00:03:01,410 A four-month investigation by KPBS and the Watchdog Institute, 62 00:03:01,410 --> 00:03:03,860 found many people who have been diagnosed 63 00:03:03,860 --> 00:03:07,140 with whooping cough were immunized. 64 00:03:07,140 --> 00:03:09,910 We also show how government data on the number 65 00:03:09,910 --> 00:03:13,350 of people diagnosed with whooping cough lacks timeliness 66 00:03:13,350 --> 00:03:16,680 and is often inconsistent, begging the question: 67 00:03:16,680 --> 00:03:19,590 just who is keeping track of this epidemic? 68 00:03:19,590 --> 00:03:21,650 We'll show you how some of the experts 69 00:03:21,650 --> 00:03:25,210 who influence vaccine policy are financially tied 70 00:03:25,210 --> 00:03:27,040 to vaccine companies. 71 00:03:27,040 --> 00:03:29,390 And, we'll follow the Bryce family as they struggle 72 00:03:29,390 --> 00:03:33,828 with their son's diagnosis, and the setbacks in his recovery. 73 00:03:36,921 --> 00:03:40,640 Whooping cough, violent cough, the hundred-day cough; 74 00:03:40,640 --> 00:03:42,370 all names for Pertussis. 75 00:03:42,370 --> 00:03:44,920 DR. JAMES CHERRY: What causes the cough actually we 76 00:03:44,920 --> 00:03:45,690 don't know... 77 00:03:45,690 --> 00:03:47,450 there's no other cough quite like it. 78 00:03:47,450 --> 00:03:50,840 FARYON: Pertussis is a respiratory illness caused 79 00:03:50,840 --> 00:03:53,430 by the bacterium Bordetella pertussis. 80 00:03:53,430 --> 00:03:55,530 At first, it can mimic a cold. 81 00:03:55,530 --> 00:03:59,070 But later produces a violent and persistent cough, 82 00:03:59,070 --> 00:04:02,090 a cough that leaves children gasping for air - 83 00:04:02,090 --> 00:04:05,200 creating the distinct whooping sound. 84 00:04:05,200 --> 00:04:08,380 For adults, whooping cough may only be a nuisance. 85 00:04:08,380 --> 00:04:11,260 In fact scientists estimate more than 80 percent 86 00:04:11,260 --> 00:04:14,130 of adult cases are never diagnosed 87 00:04:14,130 --> 00:04:17,260 because most people assume they just have a bad cold. 88 00:04:17,260 --> 00:04:20,500 But to infants whooping cough can be deadly, 89 00:04:20,500 --> 00:04:22,950 especially if not diagnosed early. 90 00:04:22,950 --> 00:04:25,390 DR. JAMES CHERRY: So with infection 91 00:04:25,390 --> 00:04:29,850 that you eventually clear the bacteria and you get better. 92 00:04:29,850 --> 00:04:34,474 But it's a prolonged, most cases ... 93 00:04:34,474 --> 00:04:37,363 a good percentage of cases in children 94 00:04:37,363 --> 00:04:39,622 will last for one or two months. 95 00:04:39,622 --> 00:04:41,686 DR. FRITS MOOI: After a pertussis infection 96 00:04:41,686 --> 00:04:45,039 you often get super infections, actually that is one 97 00:04:45,039 --> 00:04:47,090 of the main complications, pneumonia. 98 00:04:47,090 --> 00:04:50,240 FARYON: Young babies aren't able to cough up secretions 99 00:04:50,240 --> 00:04:52,610 that collect in their lungs, leading to pneumonia 100 00:04:52,610 --> 00:04:54,930 and making it difficult to breathe. 101 00:04:54,930 --> 00:04:59,490 Early antibiotic treatment is most critical in this age group. 102 00:04:59,490 --> 00:05:02,630 Whooping cough was nearly wiped out by the late 1970's 103 00:05:02,630 --> 00:05:04,910 because of mass immunization, 104 00:05:04,910 --> 00:05:07,400 but it's somehow found its way back to California 105 00:05:07,400 --> 00:05:11,290 and other highly vaccinated communities around the world. 106 00:05:11,290 --> 00:05:14,070 Just why it's made such a vengeful comeback has two 107 00:05:14,070 --> 00:05:17,580 of the world's leading whooping cough experts in disagreement. 108 00:05:17,580 --> 00:05:20,270 Dr. James Cherry of UCLA: CHERRY: 109 00:05:20,270 --> 00:05:22,530 The main reason is increased awareness. 110 00:05:22,530 --> 00:05:25,120 FARYON: and Dr. Frits Mooi of the Netherlands Centre 111 00:05:25,120 --> 00:05:26,950 for Infectious Diseases Control. 112 00:05:26,950 --> 00:05:33,350 MOOI: We found really a new mutation in the bug. 113 00:05:33,350 --> 00:05:37,120 FARYON: Dr. Mooi and Dr. Cherry both began their research 114 00:05:37,120 --> 00:05:39,750 into Whooping Cough about 30 years ago. 115 00:05:39,750 --> 00:05:42,940 Cherry in the U.S. and Mooi in The Netherlands. 116 00:05:42,940 --> 00:05:45,620 The two scientists know each other's work. 117 00:05:45,620 --> 00:05:49,790 CHERRY: First of all, his molecular microbiological science is, 118 00:05:49,790 --> 00:05:54,990 he's right at the top of scholars. 119 00:05:54,990 --> 00:05:57,370 There's no question about that. 120 00:05:57,370 --> 00:06:02,150 I think where some of the things he's published is the clinical 121 00:06:02,150 --> 00:06:04,060 data are not very good. 122 00:06:04,060 --> 00:06:07,290 MOOI: I don't communicate too much with him but what he wrote 123 00:06:07,290 --> 00:06:11,590 in the press is that I screw up epidemiology. 124 00:06:11,590 --> 00:06:13,440 That doesn't help me too much. 125 00:06:13,440 --> 00:06:16,490 FARYON: To understand why these two experts disagree, 126 00:06:16,490 --> 00:06:18,570 you need to know a little about the history 127 00:06:18,570 --> 00:06:19,850 of the pertussis vaccine. 128 00:06:19,850 --> 00:06:23,710 ANNOUNCER: Since most serious cases occur before school age, 129 00:06:23,710 --> 00:06:26,120 immunization in school may be too late. 130 00:06:26,120 --> 00:06:29,340 FARYON: The bacteria that causes whooping cough was first 131 00:06:29,340 --> 00:06:32,100 isolated in Belgium in 1906. 132 00:06:32,100 --> 00:06:33,850 At the time, the illness was one 133 00:06:33,850 --> 00:06:35,700 of the leading causes of infant death. 134 00:06:35,700 --> 00:06:40,680 ANNOUNCER: In 1921, whooping cough killed 316 135 00:06:40,680 --> 00:06:42,560 Michigan children. 136 00:06:42,560 --> 00:06:47,310 Last year, the number of deaths was reduced to 63. 137 00:06:47,310 --> 00:06:51,340 FARYON: The discovery lead to the first attempts at a vaccine. 138 00:06:51,340 --> 00:06:55,250 But it wasn't until the late 1940's scientists developed a 139 00:06:55,250 --> 00:06:58,010 vaccine effective enough to prevent whooping cough. 140 00:06:58,010 --> 00:06:59,920 ANNOUNCER: Unlike the disease however, 141 00:06:59,920 --> 00:07:01,670 a vaccine does not endanger life. 142 00:07:01,670 --> 00:07:05,350 FARYON: By 1946, mass immunization programs began 143 00:07:05,350 --> 00:07:08,850 in the U.S. and the number of cases dropped dramatically. 144 00:07:08,850 --> 00:07:10,790 Prior to the vaccine the rate 145 00:07:10,790 --> 00:07:14,800 of disease was 157 cases per 100,000. 146 00:07:14,800 --> 00:07:19,810 By the 1970's, with large scale immunizations, fewer than one 147 00:07:19,810 --> 00:07:22,670 in one hundred thousand people got whooping cough. 148 00:07:22,670 --> 00:07:26,220 But the vaccine was not without controversy. 149 00:07:26,220 --> 00:07:29,340 The early versions were associated with side effects 150 00:07:29,340 --> 00:07:32,970 such as prolonged crying spells and seizures in babies. 151 00:07:32,970 --> 00:07:37,630 By 1996, the FDA approved a new whooping cough vaccine. 152 00:07:37,630 --> 00:07:40,170 It was called an acellular version. 153 00:07:40,170 --> 00:07:43,270 That means the vaccine uses only purified components 154 00:07:43,270 --> 00:07:45,620 of the disease-causing organism. 155 00:07:45,620 --> 00:07:49,080 That vaccine was considered to be safer and associated 156 00:07:49,080 --> 00:07:51,320 with few mild side effects. 157 00:07:51,320 --> 00:07:56,508 Today, the U.S. uses only the acellular pertussis vaccine. 158 00:07:59,408 --> 00:08:02,617 But as the United States was changing vaccines something else 159 00:08:02,617 --> 00:08:04,419 was happening 160 00:08:05,788 --> 00:08:09,740 health officials across the country were reporting increasing numbers 161 00:08:09,740 --> 00:08:12,160 of positive whooping cough cases. 162 00:08:12,160 --> 00:08:16,140 And in a government lab about 30 minutes outside of Amsterdam, 163 00:08:16,140 --> 00:08:19,190 a group of scientists had discovered something else - 164 00:08:19,190 --> 00:08:22,320 the bacterium that causes whooping cough started 165 00:08:22,320 --> 00:08:23,990 to look a little different. 166 00:08:23,990 --> 00:08:28,690 MOOI: This new mutation had the effect that the bacteria started 167 00:08:28,690 --> 00:08:30,520 to produce more pertussis toxin. 168 00:08:30,520 --> 00:08:32,800 FARYON: Just whether that mutation is to blame, 169 00:08:32,800 --> 00:08:35,490 at least in part, for the California epidemic 170 00:08:35,490 --> 00:08:38,350 and outbreaks elsewhere in the world is at the heart 171 00:08:38,350 --> 00:08:40,260 of the whooping cough debate. 172 00:08:40,260 --> 00:08:44,450 Dr. Mooi believes this to be the case, but not Dr. Cherry. 173 00:08:44,450 --> 00:08:47,230 CHERRY: Even though these changes have occurred there is 174 00:08:47,230 --> 00:08:51,110 no evidence that that's lead to increased vaccine failure. 175 00:08:56,240 --> 00:08:59,670 FARYON: Here in San Diego County, more than 85 percent 176 00:08:59,670 --> 00:09:01,400 of children are immunized. 177 00:09:01,400 --> 00:09:03,190 In fact, less than three percent 178 00:09:03,190 --> 00:09:06,860 of kids entering kindergarten have not been immunized 179 00:09:06,860 --> 00:09:09,070 because of their family's personal beliefs. 180 00:09:09,070 --> 00:09:11,770 But despite the high immunization rate, 181 00:09:11,770 --> 00:09:14,510 San Diego has the second largest number 182 00:09:14,510 --> 00:09:17,660 of positive whooping cough cases in California. 183 00:09:17,660 --> 00:09:20,760 Dr. Dean Sidelinger is San Diego's deputy public 184 00:09:20,760 --> 00:09:21,710 health officer. 185 00:09:21,710 --> 00:09:22,710 DR. DEAN SIDELINGER: This is a disease 186 00:09:22,710 --> 00:09:25,150 that if someone has it it's very easily transferred 187 00:09:25,150 --> 00:09:26,770 from one person to another. 188 00:09:26,770 --> 00:09:29,100 So if you or I sitting here during this interview, 189 00:09:29,100 --> 00:09:32,090 one of us had pertussis chances are we could transmit 190 00:09:32,090 --> 00:09:33,470 that to the other person. 191 00:09:33,470 --> 00:09:34,990 Sidelinger says in the past, 192 00:09:34,990 --> 00:09:37,990 the number of whooping cough cases peaked in summer 193 00:09:37,990 --> 00:09:41,690 and slowed by fall, but this year, that didn't happen. 194 00:09:41,690 --> 00:09:45,350 SIDELINGER: So as time goes on we're seeing more cases. 195 00:09:45,350 --> 00:09:48,950 We know that public awareness plays into that as we talk 196 00:09:48,950 --> 00:09:51,480 about Pertussis more people are asking their doctors 197 00:09:51,480 --> 00:09:53,230 and doctors are asking their patients we're going 198 00:09:53,230 --> 00:09:55,410 to see more, but that trend continued. 199 00:09:55,410 --> 00:09:59,530 FARYON: By the end of November 2010, nearly 1000 infants, 200 00:09:59,530 --> 00:10:02,830 children and adults in San Diego County tested positive 201 00:10:02,830 --> 00:10:04,050 for whooping cough. 202 00:10:04,050 --> 00:10:06,760 More than half of them had been immunized. 203 00:10:06,760 --> 00:10:08,090 Our investigation shows 204 00:10:08,090 --> 00:10:10,890 that trend continues throughout California. 205 00:10:10,890 --> 00:10:14,190 KPBS and The Watchdog Institute collected data 206 00:10:14,190 --> 00:10:16,950 from 9 California counties that report some 207 00:10:16,950 --> 00:10:19,050 of the highest infection rates. 208 00:10:19,050 --> 00:10:22,590 Our research shows that where immunization history is known, 209 00:10:22,590 --> 00:10:26,240 between 44 and 83 percent of people diagnosed 210 00:10:26,240 --> 00:10:28,650 with whooping cough were vaccinated. 211 00:10:28,650 --> 00:10:30,370 We looked at California Department 212 00:10:30,370 --> 00:10:32,430 of Public Health records too. 213 00:10:32,430 --> 00:10:35,460 In cases where vaccination history was recorded, 214 00:10:35,460 --> 00:10:39,090 more than 80 percent of infected people had been immunized. 215 00:10:39,090 --> 00:10:41,050 DR. MARK HORTON: From the epidemiology experts 216 00:10:41,050 --> 00:10:45,780 and the experts in vaccine this is absolutely expected. 217 00:10:45,780 --> 00:10:48,220 FARYON: Dr. Mark Horton is the director 218 00:10:48,220 --> 00:10:50,740 of the California Department of Public Health. 219 00:10:50,740 --> 00:10:52,560 HORTON: If you've got a percentage 220 00:10:52,560 --> 00:10:56,340 of the population vaccinated and a percentage of those vaccinated 221 00:10:56,340 --> 00:10:57,440 that are still susceptible 222 00:10:57,440 --> 00:11:00,820 because the vaccine isn't perfectly effective or effective 223 00:11:00,820 --> 00:11:02,800 in all individuals, when you work 224 00:11:02,800 --> 00:11:05,050 out the arithmetic you'll see that even 225 00:11:05,050 --> 00:11:06,980 with a very effective vaccine, 226 00:11:06,980 --> 00:11:08,360 and even if you have the majority 227 00:11:08,360 --> 00:11:10,300 of the population vaccinated, 228 00:11:10,300 --> 00:11:14,130 the pool of susceptibles will include a number of individuals 229 00:11:14,130 --> 00:11:15,390 that have never been vaccinated 230 00:11:15,390 --> 00:11:19,390 but will also include quite a few and in some cases greater 231 00:11:19,390 --> 00:11:20,240 than 50 percent 232 00:11:20,240 --> 00:11:22,350 of the individuals have been previously vaccinated. 233 00:11:22,350 --> 00:11:24,670 FARYON: In other words, if you do the math, 234 00:11:24,670 --> 00:11:26,720 you will always find a certain number 235 00:11:26,720 --> 00:11:28,620 of immunized people getting sick 236 00:11:28,620 --> 00:11:31,650 if a vaccine is not 100 percent effective. 237 00:11:31,650 --> 00:11:34,930 HORTON: So that's no surprise to us nor is it a reflection 238 00:11:34,930 --> 00:11:36,520 on the efficacy of the vaccine. 239 00:11:36,520 --> 00:11:37,890 REPORTER KEVIN CROWE: It's not a reflection 240 00:11:37,890 --> 00:11:39,070 on the efficacy of the vaccine? 241 00:11:39,070 --> 00:11:39,690 HORTON: Correct, correct. 242 00:11:39,690 --> 00:11:42,560 FARYON: But 20 years ago, the reverse was true. 243 00:11:42,560 --> 00:11:44,990 According to a report by the Centers for Disease Control, 244 00:11:44,990 --> 00:11:48,420 more than half of the children between 3 months and 4 years old 245 00:11:48,420 --> 00:11:51,450 who got whooping cough nationwide between 1990 246 00:11:51,450 --> 00:11:53,900 and 1996 were not immunized. 247 00:11:53,900 --> 00:11:56,480 The rate of whooping cough has also been increasing 248 00:11:56,480 --> 00:11:58,050 for the past 20 years. 249 00:11:58,050 --> 00:12:00,900 From less than one in 100,000 250 00:12:00,900 --> 00:12:04,250 to 18 per 100,000 here in California. 251 00:12:04,250 --> 00:12:08,580 And in some California counties such as San Luis Obispo, 252 00:12:08,580 --> 00:12:12,880 rates are nearly as high as before vaccines were developed. 253 00:12:12,880 --> 00:12:14,910 Two days after our interview 254 00:12:14,910 --> 00:12:18,630 with the Bryce family, Matthew got a fever. 255 00:12:18,630 --> 00:12:21,480 He was hospitalized at Rady's Children's Hospital 256 00:12:21,480 --> 00:12:24,000 in San Diego. 257 00:12:24,000 --> 00:12:26,820 Matthew was not immunized against whooping cough. 258 00:12:26,820 --> 00:12:28,060 He's too young. 259 00:12:28,060 --> 00:12:31,900 Babies can't be immunized until they're two months old. 260 00:12:31,900 --> 00:12:34,880 But everyone else in the Bryce family was vaccinated - 261 00:12:34,880 --> 00:12:37,160 even his parents got booster shots. 262 00:12:37,160 --> 00:12:39,400 The practice of immunizing everyone 263 00:12:39,400 --> 00:12:42,030 around a newborn baby is called cocooning. 264 00:12:42,030 --> 00:12:46,860 CINDY BRYCE: When I called the doctor they asked me who has it 265 00:12:46,860 --> 00:12:50,390 and I couldn't give them an answer because I don't know 266 00:12:50,390 --> 00:12:53,460 where he got it from because everyone's been vaccinated. 267 00:12:53,460 --> 00:12:56,550 FARYON: Myron and one of his sons were also tested 268 00:12:56,550 --> 00:12:58,390 for whooping cough - both were negative. 269 00:12:58,390 --> 00:13:00,990 M. BRYCE: The one thing I would want 270 00:13:00,990 --> 00:13:05,740 to know is the vaccine working? 271 00:13:05,740 --> 00:13:11,300 Is it as effective because before this I thought the 272 00:13:11,300 --> 00:13:18,710 vaccine was working and I thought that if I did everything 273 00:13:18,710 --> 00:13:27,220 that I was told to do that our sons would be protected. 274 00:13:27,220 --> 00:13:30,140 FARYON: Just how effective is the vaccine? 275 00:13:30,140 --> 00:13:32,700 That all depends on who you talk to. 276 00:13:32,700 --> 00:13:34,250 Drug information included 277 00:13:34,250 --> 00:13:37,110 with the two most commonly used whooping cough vaccines 278 00:13:37,110 --> 00:13:40,410 in the US say the vaccine is 85 percent effective. 279 00:13:40,410 --> 00:13:44,120 MOOI: This new strain has completely invaded the 280 00:13:44,120 --> 00:13:46,490 Netherlands and also other countries and pushed 281 00:13:46,490 --> 00:13:48,290 out all the other strains. 282 00:13:48,290 --> 00:13:49,090 It's quite unique. 283 00:13:49,090 --> 00:13:51,660 FARYON: Dr. Mooi believes there's no way 284 00:13:51,660 --> 00:13:54,480 to determine how effective the vaccines are 285 00:13:54,480 --> 00:13:56,130 because they have not been tested 286 00:13:56,130 --> 00:13:58,390 against the new strain of whooping cough. 287 00:13:58,390 --> 00:13:59,740 MOOI: We call it the p3 strain. 288 00:13:59,740 --> 00:14:02,550 FARYON: A strain he believes is more virulent 289 00:14:02,550 --> 00:14:04,000 and can make people sicker. 290 00:14:04,000 --> 00:14:07,540 This strain emerged while the new acellular vaccines were 291 00:14:07,540 --> 00:14:08,380 being developed. 292 00:14:08,380 --> 00:14:09,510 MOOI: I can tell you one 293 00:14:09,510 --> 00:14:14,320 of the reasons the vaccine companies are not too happy 294 00:14:14,320 --> 00:14:20,750 with me is because if what I say is true they selected the wrong 295 00:14:20,750 --> 00:14:22,980 strains in the 1980's. 296 00:14:22,980 --> 00:14:25,440 FARYON: Mooi's lab was studying the new strain 297 00:14:25,440 --> 00:14:28,620 when The Netherlands experienced an unexpected whooping cough 298 00:14:28,620 --> 00:14:30,270 epidemic in 1996. 299 00:14:31,058 --> 00:14:33,147 MOOI: There was a very direct relationship 300 00:14:33,147 --> 00:14:37,695 between the emergence of these strains, we call them p3 strains 301 00:14:37,695 --> 00:14:40,640 and the increase in pertussis notifications. 302 00:14:40,640 --> 00:14:44,820 CHERRY: There's absolutely no evidence that either 303 00:14:44,820 --> 00:14:48,870 of the two vaccines that are most common today used 304 00:14:48,870 --> 00:14:54,330 in the U.S. that there is increased vaccine failure 305 00:14:54,330 --> 00:14:56,020 with either of those vaccines. 306 00:14:56,020 --> 00:15:01,130 FARYON: So if you had to explain why we're seeing this epidemic 307 00:15:01,130 --> 00:15:03,080 the highest number of cases in 60 years, 308 00:15:03,080 --> 00:15:04,690 what would you tell people? 309 00:15:04,690 --> 00:15:07,560 CHERRY: The main reason is increased awareness. 310 00:15:07,560 --> 00:15:12,500 People, particularly public health people are much more 311 00:15:12,500 --> 00:15:14,890 aware and that trickles down. 312 00:15:14,890 --> 00:15:17,560 FARYON: Cherry says the increase is also due in part 313 00:15:17,560 --> 00:15:19,890 because of something called waning immunity. 314 00:15:19,890 --> 00:15:23,500 Immunity to whooping cough does not last a lifetime, 315 00:15:23,500 --> 00:15:26,440 whether you are vaccinated or develop natural immunity 316 00:15:26,440 --> 00:15:27,960 from getting the disease. 317 00:15:27,960 --> 00:15:31,590 Almost all experts agree waning immunity is contributing 318 00:15:31,590 --> 00:15:34,350 to whooping cough outbreaks worldwide. 319 00:15:34,350 --> 00:15:38,574 Where they disagree: when does immunity fail? 320 00:15:41,066 --> 00:15:45,300 Dr. Mooi believes the new strain of Pertussis causes immunity 321 00:15:45,300 --> 00:15:47,400 to fail sooner than in the past. 322 00:15:47,400 --> 00:15:49,180 And he's published his findings 323 00:15:49,180 --> 00:15:52,510 in several peer reviewed journals including the CDC's 324 00:15:52,510 --> 00:15:54,010 Infectious Diseases. 325 00:15:54,010 --> 00:15:59,280 MOOI: When the immunity is sub-optimal what will happen the 326 00:15:59,280 --> 00:16:04,300 bacteria will not be recognized very well by the immune system 327 00:16:04,300 --> 00:16:08,330 because of the mismatch and second of all even 328 00:16:08,330 --> 00:16:10,710 if immune response is started 329 00:16:10,710 --> 00:16:14,740 in the body the toxin will be able to delay it. 330 00:16:14,740 --> 00:16:19,920 You could say these two changes work together 331 00:16:19,920 --> 00:16:22,460 by decreasing the period 332 00:16:22,460 --> 00:16:25,830 of which the vaccine is protective further. 333 00:16:25,830 --> 00:16:27,900 FARYON: The Netherlands learned something else 334 00:16:27,900 --> 00:16:30,350 after its 1996 epidemic. 335 00:16:30,350 --> 00:16:33,320 At the time, it had very few samples of the bacteria 336 00:16:33,320 --> 00:16:35,850 that was causing people to get sick. 337 00:16:35,850 --> 00:16:38,790 So Mooi's lab began asking doctors and their labs 338 00:16:38,790 --> 00:16:41,460 to send him positive Pertussis swabs. 339 00:16:41,460 --> 00:16:44,700 His lab now has 3,000 samples. 340 00:16:44,700 --> 00:16:47,920 California has collected just 29 samples from the more 341 00:16:47,920 --> 00:16:51,550 than 7,000 whooping cough cases in the state. 342 00:16:51,550 --> 00:16:55,080 During the KPBS/Watchdog four month investigation, 343 00:16:55,080 --> 00:16:57,170 we also learned data kept by the state 344 00:16:57,170 --> 00:17:00,890 and the CDC was often lagging behind county data 345 00:17:00,890 --> 00:17:02,700 and was inconsistent. 346 00:17:02,700 --> 00:17:05,860 While counties like San Diego knew the immunization status 347 00:17:05,860 --> 00:17:08,540 of the vast majority of people with whooping cough, 348 00:17:08,540 --> 00:17:11,770 the state's data listed the information as unknown. 349 00:17:11,770 --> 00:17:15,180 Despite statewide protocols for reporting pertussis, 350 00:17:15,180 --> 00:17:19,230 a KPBS/Watchdog survey found some counties don't follow them 351 00:17:19,230 --> 00:17:22,140 or are slow to report the information HORTON: 352 00:17:22,140 --> 00:17:24,930 There's a perception that the more numbers the better, 353 00:17:24,930 --> 00:17:30,460 but let me be very clear we in no way need reports 354 00:17:30,460 --> 00:17:33,050 on every single case of pertussis for us 355 00:17:33,050 --> 00:17:37,040 to make important judgments and decisions 356 00:17:37,040 --> 00:17:38,330 about what's happening. 357 00:17:38,330 --> 00:17:41,490 FARYON: The CDC in Atlanta declined our requests 358 00:17:41,490 --> 00:17:42,570 for an interview. 359 00:17:42,570 --> 00:17:45,480 In an email response they said it is "difficult 360 00:17:45,480 --> 00:17:49,380 to disentangle all the factors" contributing to increases 361 00:17:49,380 --> 00:17:52,870 in pertussis, but listed "increasing transmission, 362 00:17:52,870 --> 00:17:54,360 better recognition, 363 00:17:54,360 --> 00:17:57,300 and increased laboratory confirmation." 364 00:17:57,300 --> 00:18:00,300 We also asked whether a new more virulent strain could be 365 00:18:00,300 --> 00:18:02,060 contributing to the outbreak. 366 00:18:02,060 --> 00:18:05,790 The CDC's response: "Available data do not suggest 367 00:18:05,790 --> 00:18:08,350 that ptxP3 is more virulent, 368 00:18:08,350 --> 00:18:11,420 or that increasing reports are attributable only 369 00:18:11,420 --> 00:18:14,270 to the emergence of ptxP3. 370 00:18:14,270 --> 00:18:18,360 We continue to work on this and other potential explanations 371 00:18:18,360 --> 00:18:20,460 for the increase in pertussis 372 00:18:20,460 --> 00:18:23,780 that has occurred since the 1980s." 373 00:18:23,780 --> 00:18:26,940 The CDC sent us this study by their own investigators. 374 00:18:26,940 --> 00:18:28,180 The study looked at children 375 00:18:28,180 --> 00:18:30,950 between 6 months and five years old. 376 00:18:30,950 --> 00:18:33,080 It found pertussis vaccines to be more 377 00:18:33,080 --> 00:18:35,240 than 90 percent effective. 378 00:18:35,240 --> 00:18:39,600 The study looked at data between 1998 and 2001. 379 00:18:39,600 --> 00:18:42,710 It did not collect pertussis strain information. 380 00:18:42,710 --> 00:18:46,850 SINGING: Do you happen to know what a T-dap is? 381 00:18:46,850 --> 00:18:51,829 It's a special vaccine but it's not just for kids. 382 00:18:53,260 --> 00:18:55,940 FARYON: Sanofi Pastuer, one of two companies 383 00:18:55,940 --> 00:18:59,360 that make the vaccine widely used in the U.S., 384 00:18:59,360 --> 00:19:02,330 sponsored this singing competition earlier this year. 385 00:19:02,330 --> 00:19:07,070 SINGING: Pertussis is the reason why you should call your 386 00:19:07,070 --> 00:19:09,010 doctor today. 387 00:19:09,010 --> 00:19:11,410 FARYON: It was a public relations exercise 388 00:19:11,410 --> 00:19:15,040 to get the word out about whooping cough and immunization. 389 00:19:15,040 --> 00:19:18,320 But just where is the line between good PR and trying 390 00:19:18,320 --> 00:19:20,750 to influence public health policy? 391 00:19:20,750 --> 00:19:23,990 SINGING: Take a shot and give pertussis a whooping. 392 00:19:23,990 --> 00:19:28,700 FARYON: Especially when public health policy can increase 393 00:19:28,700 --> 00:19:30,140 vaccine sales. 394 00:19:30,140 --> 00:19:33,040 Since 2007, the California department 395 00:19:33,040 --> 00:19:36,030 of health has spent more than $200 million 396 00:19:36,030 --> 00:19:39,430 on pertussis vaccines for children on medical 397 00:19:39,430 --> 00:19:41,060 or who are under-insured. 398 00:19:41,060 --> 00:19:43,510 And it's sure to rise. 399 00:19:43,510 --> 00:19:47,840 In September, the California state legislature passed a law 400 00:19:47,840 --> 00:19:50,810 requiring all students to receive another dose, 401 00:19:50,810 --> 00:19:54,200 a sixth dose of the pertussis vaccine before entering 402 00:19:54,200 --> 00:19:55,360 middle school. 403 00:19:55,360 --> 00:19:57,110 It may be a case of what's good 404 00:19:57,110 --> 00:19:59,850 for business is also good for public health. 405 00:19:59,850 --> 00:20:02,340 But how much influence does industry have 406 00:20:02,340 --> 00:20:04,150 over public health policy? 407 00:20:04,150 --> 00:20:06,470 Sanofi Pasteur also established 408 00:20:06,470 --> 00:20:09,390 and funds The Global Pertussis Initiative. 409 00:20:09,390 --> 00:20:13,340 A group made up of medical experts from around the world. 410 00:20:13,340 --> 00:20:15,720 The GPI was established 10 years ago 411 00:20:15,720 --> 00:20:19,980 to study why pertussis was making a comeback and find ways 412 00:20:19,980 --> 00:20:21,550 to control the disease. 413 00:20:21,550 --> 00:20:23,340 More than half its members are employees 414 00:20:23,340 --> 00:20:25,050 of the pharmaceutical company 415 00:20:25,050 --> 00:20:28,170 or receive research money or consulting fees. 416 00:20:28,170 --> 00:20:31,460 Public officials from across the country, including California 417 00:20:31,460 --> 00:20:34,880 and the CDC, site the Global Pertussis Initiative 418 00:20:34,880 --> 00:20:37,210 when making vaccine policy. 419 00:20:37,210 --> 00:20:40,140 Dr. James Cherry is a member of the initiative. 420 00:20:40,140 --> 00:20:43,240 He's also received speaking fees and research funds 421 00:20:43,240 --> 00:20:45,320 from vaccine manufacturers. 422 00:20:45,320 --> 00:20:48,080 At the same time, he sat on government committees 423 00:20:48,080 --> 00:20:51,420 to help determine vaccine policy and efficacy. 424 00:20:51,420 --> 00:20:56,450 FARYON: A cynic might say that if you have a community 425 00:20:56,450 --> 00:21:01,260 of experts in pertussis as in the Global Pertussis Initiative, 426 00:21:01,260 --> 00:21:03,940 who primarily their work in terms 427 00:21:03,940 --> 00:21:06,370 of this endeavor is being funded by the drug company 428 00:21:06,370 --> 00:21:10,120 that makes the vaccine, there might be less incentive 429 00:21:10,120 --> 00:21:13,810 to say make a new vaccine and more incentive 430 00:21:13,810 --> 00:21:16,410 to say just use the old one more often. 431 00:21:16,410 --> 00:21:17,840 What do you say to them? 432 00:21:17,840 --> 00:21:19,920 CHERRY: I don't think that's true. 433 00:21:19,920 --> 00:21:25,500 I think that we've been talking about new vaccines. 434 00:21:25,500 --> 00:21:32,490 It think the difficulty with the new vaccine lies in the expense 435 00:21:32,490 --> 00:21:39,420 that it would cost to make a new vaccine and the difficulty 436 00:21:39,420 --> 00:21:46,040 in testing it because of FDA requirements for it and I think 437 00:21:46,040 --> 00:21:48,880 if the climate was right for either of two 438 00:21:48,880 --> 00:21:52,270 of the major manufacturers they would do it. 439 00:21:52,270 --> 00:21:55,480 MOOI: And these are three different pertussis strains. 440 00:21:55,480 --> 00:21:59,220 FARYON: Dr. Mooi is a critic of the Pertussis Initiative. 441 00:21:59,220 --> 00:22:04,630 MOOI: My big disappointment is they have totally 442 00:22:04,630 --> 00:22:09,090 and I think willfully ignored pathogen adaptation. 443 00:22:09,090 --> 00:22:15,500 I think a few years ago we had the year 444 00:22:15,500 --> 00:22:21,110 that Darwin died 100 year ago, it was not so long ago, 445 00:22:21,110 --> 00:22:25,460 I think it's very strange that evolution 446 00:22:25,460 --> 00:22:29,180 and pathogen adaptation is completely ignored 447 00:22:29,180 --> 00:22:30,200 by such a group. 448 00:22:30,200 --> 00:22:35,060 I find that bad for science and bad for public health. 449 00:22:35,060 --> 00:22:38,140 FARYON: Sanofi Pasteur released this statement to KPBS 450 00:22:38,140 --> 00:22:40,310 and the Watchdog Institute. 451 00:22:40,310 --> 00:22:44,150 It says its grant to the GPI brings the world's authorities 452 00:22:44,150 --> 00:22:48,500 on pertussis together and that benefits society as a whole. 453 00:22:48,500 --> 00:22:50,930 The company also says "at the present time, 454 00:22:50,930 --> 00:22:54,860 there is no evidence to suggest current pertussis vaccines 455 00:22:54,860 --> 00:22:56,800 lack effectiveness." 456 00:22:56,800 --> 00:23:00,640 Dr. Dean Sidelinger was one of the first health officials 457 00:23:00,640 --> 00:23:03,770 to learn immunized people were getting sick in his county. 458 00:23:03,770 --> 00:23:06,780 He said he was surprised, but in the end, 459 00:23:06,780 --> 00:23:10,760 he says the current vaccine is still the best thing he's got 460 00:23:10,760 --> 00:23:12,280 to protect his community. 461 00:23:12,280 --> 00:23:14,090 SIDELINGER: It does significantly decrease the 462 00:23:14,090 --> 00:23:17,010 pertussis we see a significantly lower number 463 00:23:17,010 --> 00:23:20,190 of pertussis cases now then we saw before we started using 464 00:23:20,190 --> 00:23:21,280 the vaccine. 465 00:23:21,280 --> 00:23:25,050 So we don't want people to feel complacent or to say I don't want 466 00:23:25,050 --> 00:23:27,340 that vaccine because I've seen many of the cases 467 00:23:27,340 --> 00:23:29,810 that have been reported were fully vaccinated. 468 00:23:29,810 --> 00:23:32,430 FARYON: Sidelinger says there would be many more cases 469 00:23:32,430 --> 00:23:34,700 if there was no vaccine at all. 470 00:23:34,700 --> 00:23:36,040 Dr. Mooi agrees. 471 00:23:36,040 --> 00:23:38,960 He believes public health officials should be encouraging 472 00:23:38,960 --> 00:23:43,500 cocooning, immunizing all those around newborn babies. 473 00:23:43,500 --> 00:23:48,940 But in the long run he says, we need better vaccines. 474 00:23:48,940 --> 00:23:51,800 Baby Matthew spent four days in the hospital 475 00:23:51,800 --> 00:23:54,250 and was eventually discharged. 476 00:23:54,250 --> 00:23:57,400 Today, he's getting his two-month routine check-up. 477 00:23:57,400 --> 00:24:00,100 DOCTOR: I think it was just bad luck he's had two illnesses 478 00:24:00,100 --> 00:24:04,500 in a row and now the cold he's building up his immunity. 479 00:24:04,500 --> 00:24:08,160 FARYON: Despite a stuffy nose, Matthew is doing well today. 480 00:24:08,160 --> 00:24:11,270 DCOTOR: As you might know the vaccine is not 481 00:24:11,270 --> 00:24:13,160 as effective as we want it to be. 482 00:24:13,160 --> 00:24:17,210 And that's one reason why there've been a lot of cases going around. 483 00:24:17,210 --> 00:24:21,527 But with Matthew in particular, his own immunity has kicked in 484 00:24:21,527 --> 00:24:24,690 from having the illness, that is, in effect a sort 485 00:24:24,690 --> 00:24:27,520 of a booster that will protect him going forward. 486 00:24:27,520 --> 00:24:31,325 And how long that immunity lasts is still a question. 487 00:24:31,710 --> 00:24:34,938 MARLON: The one thing I would want to say to parents is just ... 488 00:24:36,569 --> 00:24:39,347 is just watch your kids ... 489 00:24:39,408 --> 00:24:40,770 just be ... 490 00:24:45,000 --> 00:24:47,389 just be concerned. 491 00:24:47,389 --> 00:24:50,700 Because at first we thought we were being over protective. 492 00:24:51,623 --> 00:24:57,360 But I'm glad we were just a little bit over-concerned. 493 00:24:57,360 --> 00:25:00,910 FARYON: Since KPBS and the Watchdog Institute began its 494 00:25:00,910 --> 00:25:04,540 investigation, state health officials, the CDC 495 00:25:04,540 --> 00:25:08,160 and scientists from UCLA, including Dr. James Cherry, 496 00:25:08,160 --> 00:25:11,590 began a new study to determine whether the new strain 497 00:25:11,590 --> 00:25:13,450 of pertussis is contributing 498 00:25:13,450 --> 00:25:15,990 to the current whooping cough outbreak. 499 00:25:15,990 --> 00:25:18,610 For more on this story, and to see more of the data collected 500 00:25:18,610 --> 00:25:24,370 in our investigation, go to kpbs.org/whoopingcough 501 00:25:24,370 --> 00:25:27,760 and watchdoginstitute.org. 502 00:25:27,760 --> 00:25:30,210 For KPBS, the Watchdog Institute 503 00:25:30,210 --> 00:25:33,410 and Radio Netherlands Worldwide, I'm Joanne Faryon. 504 00:25:33,410 --> 00:25:35,912 Thanks for watching.