WEBVTT 00:00:09.097 --> 00:00:12.022 JOANNE FARYON: Hello, Saya Joanne Faryon. 00:00:12.022 --> 00:00:15.060 Selamat datang di acara khusus malam ini, Ketika Kekebalan Tubuh Gagal: 00:00:15.060 --> 00:00:17.078 Epidemik Batuk Pertussis 00:00:17.078 --> 00:00:21.055 Kita akan mendalami batuk pertussis terparah yang merajalela di California 00:00:21.055 --> 00:00:23.051 dalam 60 tahun ini. 00:00:23.051 --> 00:00:26.089 Mengapakah penyakit yang hampir punah 30 tahun yang lalu ini, 00:00:26.089 --> 00:00:30.092 kini kembali lagi, dan yang lebih parah 00:00:30.092 --> 00:00:32.046 menyerang ke seluruh negara di dunia? 00:00:32.046 --> 00:00:34.078 Apa yang kami temukan mungkin akan mengagetkan. 00:00:34.078 --> 00:00:37.064 Pertanyaan serius tentang seberapa kuatkah vaksin 00:00:37.064 --> 00:00:39.089 dapat mencegah penyebarluasan penyakit 00:00:39.089 --> 00:00:42.031 pertanyaan-pertanyaan resmi ke departemen kesehatan 00:00:42.031 --> 00:00:44.013 yang lamban direspon. 00:00:44.013 --> 00:00:47.021 KBPS bergabung bersama Watchdog Institute, 00:00:47.021 --> 00:00:48.096 sebuah pusat investigasi jurnalisme 00:00:48.096 --> 00:00:51.022 di Universitas San Diego, 00:00:51.022 --> 00:00:54.045 dan jaringan Radio Netherlands Worldwide untuk mengungkap kisah ini. 00:00:54.045 --> 00:00:57.000 Kisah yang membawa kita melintasi California 00:00:57.000 --> 00:00:59.063 hingga ke Amsterdam. 00:00:59.063 --> 00:01:02.036 But first, we begin in a delivery room 00:01:02.036 --> 00:01:06.060 in a San Diego hospital, where a mother has just given birth 00:01:06.060 --> 00:01:08.030 to her third son. 00:01:08.030 --> 00:01:15.014 [ baby crying ] 00:01:15.014 --> 00:01:19.018 Matthew Jacob Bryce was born Oct 11, 2010. 00:01:19.018 --> 00:01:23.070 A healthy baby, the third boy for Cindy and Marlon Bryce. 00:01:23.070 --> 00:01:25.076 Matthew started showing signs of a cold 00:01:25.076 --> 00:01:27.045 when he was just two weeks old. 00:01:27.045 --> 00:01:29.073 The Bryce family knew something was wrong. 00:01:29.073 --> 00:01:31.034 MARLON BRYCE: It just seemed 00:01:31.034 --> 00:01:35.064 like this cold it was just affecting his breathing. 00:01:35.064 --> 00:01:38.070 FARYON: The family was aware of the whooping cough epidemic 00:01:38.070 --> 00:01:40.054 in California, from news reports REPORTER: 00:01:40.054 --> 00:01:43.012 State health officials say more than 6,400 cases 00:01:43.012 --> 00:01:44.092 of whooping cough have been reported this year. 00:01:44.092 --> 00:01:46.070 FARYON: And their pediatrician. 00:01:46.070 --> 00:01:48.029 BRYCE: There wasn't any whooping 00:01:48.029 --> 00:01:52.051 or they always say there is a whooping or a cough, 00:01:52.051 --> 00:01:54.048 he didn't have a cough or anything it was just 00:01:54.048 --> 00:01:55.043 that there was a cold. 00:01:55.043 --> 00:01:58.062 FARYON: Matthew's doctor suspected it could be whooping 00:01:58.062 --> 00:02:00.081 cough, also known as Pertussis. 00:02:00.081 --> 00:02:03.067 She took a nasal swab and sent it to the lab. 00:02:03.067 --> 00:02:06.050 She also started Matthew on antibiotics. 00:02:06.050 --> 00:02:09.096 Six days later, with Matthew just 23 days old, 00:02:09.096 --> 00:02:11.037 Cindy Bryce got a phone call 00:02:11.037 --> 00:02:13.047 from the California Department of Health. 00:02:13.047 --> 00:02:15.093 The diagnosis was whooping cough. 00:02:15.093 --> 00:02:20.086 M. BRYCE: The moment I heard it I just immediately started 00:02:20.086 --> 00:02:26.005 thinking the worst because you have heard the news 00:02:26.005 --> 00:02:28.068 about the babies that have passed away. 00:02:28.068 --> 00:02:31.077 FARYON: From January to October this year, 00:02:31.077 --> 00:02:35.006 10 newborns in California died from whooping cough, 00:02:35.006 --> 00:02:37.015 two in San Diego County. 00:02:37.015 --> 00:02:40.044 More than 7,000 children and adults got sick 00:02:40.044 --> 00:02:43.037 from the disease - the highest number in the state 00:02:43.037 --> 00:02:45.019 in more than 60 years. 00:02:45.019 --> 00:02:48.087 Just how did Matthew and so many others come down with a disease 00:02:48.087 --> 00:02:51.096 that is supposed to be preventable with a vaccine? 00:02:51.096 --> 00:02:53.096 Tonight we'll raise questions 00:02:53.096 --> 00:02:56.090 about the effectiveness of that vaccine. 00:02:56.090 --> 00:03:01.040 A four-month investigation by KPBS and the Watchdog Institute, 00:03:01.040 --> 00:03:03.086 found many people who have been diagnosed 00:03:03.086 --> 00:03:07.013 with whooping cough were immunized. 00:03:07.013 --> 00:03:09.090 We also show how government data on the number 00:03:09.090 --> 00:03:13.034 of people diagnosed with whooping cough lacks timeliness 00:03:13.034 --> 00:03:16.068 and is often inconsistent, begging the question: 00:03:16.068 --> 00:03:19.059 just who is keeping track of this epidemic? 00:03:19.059 --> 00:03:21.065 We'll show you how some of the experts 00:03:21.065 --> 00:03:25.021 who influence vaccine policy are financially tied 00:03:25.021 --> 00:03:27.003 to vaccine companies. 00:03:27.003 --> 00:03:29.038 And, we'll follow the Bryce family as they struggle 00:03:29.038 --> 00:03:33.082 with their son's diagnosis, and the setbacks in his recovery. 00:03:36.092 --> 00:03:40.063 Whooping cough, violent cough, the hundred-day cough; 00:03:40.063 --> 00:03:42.037 all names for Pertussis. 00:03:42.037 --> 00:03:44.091 DR. JAMES CHERRY: What causes the cough actually we 00:03:44.091 --> 00:03:45.068 don't know... 00:03:45.068 --> 00:03:47.044 there's no other cough quite like it. 00:03:47.044 --> 00:03:50.084 FARYON: Pertussis is a respiratory illness caused 00:03:50.084 --> 00:03:53.043 by the bacterium Bordetella pertussis. 00:03:53.043 --> 00:03:55.053 At first, it can mimic a cold. 00:03:55.053 --> 00:03:59.006 But later produces a violent and persistent cough, 00:03:59.006 --> 00:04:02.009 a cough that leaves children gasping for air - 00:04:02.009 --> 00:04:05.019 creating the distinct whooping sound. 00:04:05.019 --> 00:04:08.037 For adults, whooping cough may only be a nuisance. 00:04:08.037 --> 00:04:11.025 In fact scientists estimate more than 80 percent 00:04:11.025 --> 00:04:14.012 of adult cases are never diagnosed 00:04:14.012 --> 00:04:17.025 because most people assume they just have a bad cold. 00:04:17.025 --> 00:04:20.050 But to infants whooping cough can be deadly, 00:04:20.050 --> 00:04:22.094 especially if not diagnosed early. 00:04:22.094 --> 00:04:25.038 DR. JAMES CHERRY: So with infection 00:04:25.038 --> 00:04:29.085 that you eventually clear the bacteria and you get better. 00:04:29.085 --> 00:04:34.047 But it's a prolonged, most cases ... 00:04:34.047 --> 00:04:37.036 a good percentage of cases in children 00:04:37.036 --> 00:04:39.062 will last for one or two months. 00:04:39.062 --> 00:04:41.068 DR. FRITS MOOI: After a pertussis infection 00:04:41.068 --> 00:04:45.003 you often get super infections, actually that is one 00:04:45.003 --> 00:04:47.008 of the main complications, pneumonia. 00:04:47.008 --> 00:04:50.024 FARYON: Young babies aren't able to cough up secretions 00:04:50.024 --> 00:04:52.061 that collect in their lungs, leading to pneumonia 00:04:52.061 --> 00:04:54.093 and making it difficult to breathe. 00:04:54.093 --> 00:04:59.049 Early antibiotic treatment is most critical in this age group. 00:04:59.049 --> 00:05:02.062 Whooping cough was nearly wiped out by the late 1970's 00:05:02.062 --> 00:05:04.091 because of mass immunization, 00:05:04.091 --> 00:05:07.039 but it's somehow found its way back to California 00:05:07.039 --> 00:05:11.029 and other highly vaccinated communities around the world. 00:05:11.029 --> 00:05:14.006 Just why it's made such a vengeful comeback has two 00:05:14.006 --> 00:05:17.057 of the world's leading whooping cough experts in disagreement. 00:05:17.057 --> 00:05:20.026 Dr. James Cherry of UCLA: CHERRY: 00:05:20.026 --> 00:05:22.052 The main reason is increased awareness. 00:05:22.052 --> 00:05:25.012 FARYON: and Dr. Frits Mooi of the Netherlands Centre 00:05:25.012 --> 00:05:26.094 for Infectious Diseases Control. 00:05:26.094 --> 00:05:33.035 MOOI: We found really a new mutation in the bug. 00:05:33.035 --> 00:05:37.012 FARYON: Dr. Mooi and Dr. Cherry both began their research 00:05:37.012 --> 00:05:39.075 into Whooping Cough about 30 years ago. 00:05:39.075 --> 00:05:42.093 Cherry in the U.S. and Mooi in The Netherlands. 00:05:42.093 --> 00:05:45.062 The two scientists know each other's work. 00:05:45.062 --> 00:05:49.079 CHERRY: First of all, his molecular microbiological science is, 00:05:49.079 --> 00:05:54.099 he's right at the top of scholars. 00:05:54.099 --> 00:05:57.037 There's no question about that. 00:05:57.037 --> 00:06:02.014 I think where some of the things he's published is the clinical 00:06:02.014 --> 00:06:04.006 data are not very good. 00:06:04.006 --> 00:06:07.029 MOOI: I don't communicate too much with him but what he wrote 00:06:07.029 --> 00:06:11.058 in the press is that I screw up epidemiology. 00:06:11.058 --> 00:06:13.043 That doesn't help me too much. 00:06:13.043 --> 00:06:16.049 FARYON: To understand why these two experts disagree, 00:06:16.049 --> 00:06:18.056 you need to know a little about the history 00:06:18.056 --> 00:06:19.085 of the pertussis vaccine. 00:06:19.085 --> 00:06:23.070 ANNOUNCER: Since most serious cases occur before school age, 00:06:23.070 --> 00:06:26.012 immunization in school may be too late. 00:06:26.012 --> 00:06:29.033 FARYON: The bacteria that causes whooping cough was first 00:06:29.033 --> 00:06:32.010 isolated in Belgium in 1906. 00:06:32.010 --> 00:06:33.085 At the time, the illness was one 00:06:33.085 --> 00:06:35.069 of the leading causes of infant death. 00:06:35.069 --> 00:06:40.068 ANNOUNCER: In 1921, whooping cough killed 316 00:06:40.068 --> 00:06:42.056 Michigan children. 00:06:42.056 --> 00:06:47.031 Last year, the number of deaths was reduced to 63. 00:06:47.031 --> 00:06:51.033 FARYON: The discovery lead to the first attempts at a vaccine. 00:06:51.033 --> 00:06:55.025 But it wasn't until the late 1940's scientists developed a 00:06:55.025 --> 00:06:58.000 vaccine effective enough to prevent whooping cough. 00:06:58.000 --> 00:06:59.092 ANNOUNCER: Unlike the disease however, 00:06:59.092 --> 00:07:01.067 a vaccine does not endanger life. 00:07:01.067 --> 00:07:05.035 FARYON: By 1946, mass immunization programs began 00:07:05.035 --> 00:07:08.085 in the U.S. and the number of cases dropped dramatically. 00:07:08.085 --> 00:07:10.079 Prior to the vaccine the rate 00:07:10.079 --> 00:07:14.080 of disease was 157 cases per 100,000. 00:07:14.080 --> 00:07:19.081 By the 1970's, with large scale immunizations, fewer than one 00:07:19.081 --> 00:07:22.067 in one hundred thousand people got whooping cough. 00:07:22.067 --> 00:07:26.022 But the vaccine was not without controversy. 00:07:26.022 --> 00:07:29.033 The early versions were associated with side effects 00:07:29.033 --> 00:07:32.097 such as prolonged crying spells and seizures in babies. 00:07:32.097 --> 00:07:37.062 By 1996, the FDA approved a new whooping cough vaccine. 00:07:37.062 --> 00:07:40.017 It was called an acellular version. 00:07:40.017 --> 00:07:43.026 That means the vaccine uses only purified components 00:07:43.026 --> 00:07:45.062 of the disease-causing organism. 00:07:45.062 --> 00:07:49.007 That vaccine was considered to be safer and associated 00:07:49.007 --> 00:07:51.031 with few mild side effects. 00:07:51.031 --> 00:07:56.050 Today, the U.S. uses only the acellular pertussis vaccine. 00:07:59.040 --> 00:08:02.061 But as the United States was changing vaccines something else 00:08:02.061 --> 00:08:04.041 was happening 00:08:05.078 --> 00:08:09.074 health officials across the country were reporting increasing numbers 00:08:09.074 --> 00:08:12.016 of positive whooping cough cases. 00:08:12.016 --> 00:08:16.013 And in a government lab about 30 minutes outside of Amsterdam, 00:08:16.013 --> 00:08:19.018 a group of scientists had discovered something else - 00:08:19.018 --> 00:08:22.031 the bacterium that causes whooping cough started 00:08:22.031 --> 00:08:23.099 to look a little different. 00:08:23.099 --> 00:08:28.068 MOOI: This new mutation had the effect that the bacteria started 00:08:28.068 --> 00:08:30.051 to produce more pertussis toxin. 00:08:30.051 --> 00:08:32.079 FARYON: Just whether that mutation is to blame, 00:08:32.079 --> 00:08:35.049 at least in part, for the California epidemic 00:08:35.049 --> 00:08:38.035 and outbreaks elsewhere in the world is at the heart 00:08:38.035 --> 00:08:40.025 of the whooping cough debate. 00:08:40.025 --> 00:08:44.045 Dr. Mooi believes this to be the case, but not Dr. Cherry. 00:08:44.045 --> 00:08:47.023 CHERRY: Even though these changes have occurred there is 00:08:47.023 --> 00:08:51.011 no evidence that that's lead to increased vaccine failure. 00:08:56.024 --> 00:08:59.066 FARYON: Here in San Diego County, more than 85 percent 00:08:59.066 --> 00:09:01.039 of children are immunized. 00:09:01.039 --> 00:09:03.019 In fact, less than three percent 00:09:03.019 --> 00:09:06.086 of kids entering kindergarten have not been immunized 00:09:06.086 --> 00:09:09.007 because of their family's personal beliefs. 00:09:09.007 --> 00:09:11.076 But despite the high immunization rate, 00:09:11.076 --> 00:09:14.050 San Diego has the second largest number 00:09:14.050 --> 00:09:17.065 of positive whooping cough cases in California. 00:09:17.065 --> 00:09:20.075 Dr. Dean Sidelinger is San Diego's deputy public 00:09:20.075 --> 00:09:21.071 health officer. 00:09:21.071 --> 00:09:22.071 DR. DEAN SIDELINGER: This is a disease 00:09:22.071 --> 00:09:25.014 that if someone has it it's very easily transferred 00:09:25.014 --> 00:09:26.076 from one person to another. 00:09:26.076 --> 00:09:29.010 So if you or I sitting here during this interview, 00:09:29.010 --> 00:09:32.009 one of us had pertussis chances are we could transmit 00:09:32.009 --> 00:09:33.047 that to the other person. 00:09:33.047 --> 00:09:34.099 Sidelinger says in the past, 00:09:34.099 --> 00:09:37.099 the number of whooping cough cases peaked in summer 00:09:37.099 --> 00:09:41.069 and slowed by fall, but this year, that didn't happen. 00:09:41.069 --> 00:09:45.035 SIDELINGER: So as time goes on we're seeing more cases. 00:09:45.035 --> 00:09:48.095 We know that public awareness plays into that as we talk 00:09:48.095 --> 00:09:51.048 about Pertussis more people are asking their doctors 00:09:51.048 --> 00:09:53.023 and doctors are asking their patients we're going 00:09:53.023 --> 00:09:55.040 to see more, but that trend continued. 00:09:55.040 --> 00:09:59.052 FARYON: By the end of November 2010, nearly 1000 infants, 00:09:59.052 --> 00:10:02.083 children and adults in San Diego County tested positive 00:10:02.083 --> 00:10:04.004 for whooping cough. 00:10:04.004 --> 00:10:06.075 More than half of them had been immunized. 00:10:06.075 --> 00:10:08.009 Our investigation shows 00:10:08.009 --> 00:10:10.088 that trend continues throughout California. 00:10:10.088 --> 00:10:14.019 KPBS and The Watchdog Institute collected data 00:10:14.019 --> 00:10:16.095 from 9 California counties that report some 00:10:16.095 --> 00:10:19.004 of the highest infection rates. 00:10:19.004 --> 00:10:22.059 Our research shows that where immunization history is known, 00:10:22.059 --> 00:10:26.024 between 44 and 83 percent of people diagnosed 00:10:26.024 --> 00:10:28.064 with whooping cough were vaccinated. 00:10:28.064 --> 00:10:30.037 We looked at California Department 00:10:30.037 --> 00:10:32.042 of Public Health records too. 00:10:32.042 --> 00:10:35.046 In cases where vaccination history was recorded, 00:10:35.046 --> 00:10:39.009 more than 80 percent of infected people had been immunized. 00:10:39.009 --> 00:10:41.004 DR. MARK HORTON: From the epidemiology experts 00:10:41.004 --> 00:10:45.077 and the experts in vaccine this is absolutely expected. 00:10:45.077 --> 00:10:48.022 FARYON: Dr. Mark Horton is the director 00:10:48.022 --> 00:10:50.074 of the California Department of Public Health. 00:10:50.074 --> 00:10:52.055 HORTON: If you've got a percentage 00:10:52.055 --> 00:10:56.034 of the population vaccinated and a percentage of those vaccinated 00:10:56.034 --> 00:10:57.044 that are still susceptible 00:10:57.044 --> 00:11:00.082 because the vaccine isn't perfectly effective or effective 00:11:00.082 --> 00:11:02.079 in all individuals, when you work 00:11:02.079 --> 00:11:05.004 out the arithmetic you'll see that even 00:11:05.004 --> 00:11:06.098 with a very effective vaccine, 00:11:06.098 --> 00:11:08.036 and even if you have the majority 00:11:08.036 --> 00:11:10.029 of the population vaccinated, 00:11:10.029 --> 00:11:14.012 the pool of susceptibles will include a number of individuals 00:11:14.012 --> 00:11:15.038 that have never been vaccinated 00:11:15.038 --> 00:11:19.038 but will also include quite a few and in some cases greater 00:11:19.038 --> 00:11:20.024 than 50 percent 00:11:20.024 --> 00:11:22.035 of the individuals have been previously vaccinated. 00:11:22.035 --> 00:11:24.066 FARYON: In other words, if you do the math, 00:11:24.066 --> 00:11:26.072 you will always find a certain number 00:11:26.072 --> 00:11:28.062 of immunized people getting sick 00:11:28.062 --> 00:11:31.064 if a vaccine is not 100 percent effective. 00:11:31.064 --> 00:11:34.092 HORTON: So that's no surprise to us nor is it a reflection 00:11:34.092 --> 00:11:36.051 on the efficacy of the vaccine. 00:11:36.051 --> 00:11:37.088 REPORTER KEVIN CROWE: It's not a reflection 00:11:37.088 --> 00:11:39.007 on the efficacy of the vaccine? 00:11:39.007 --> 00:11:39.069 HORTON: Correct, correct. 00:11:39.069 --> 00:11:42.055 FARYON: But 20 years ago, the reverse was true. 00:11:42.055 --> 00:11:44.099 According to a report by the Centers for Disease Control, 00:11:44.099 --> 00:11:48.041 more than half of the children between 3 months and 4 years old 00:11:48.041 --> 00:11:51.045 who got whooping cough nationwide between 1990 00:11:51.045 --> 00:11:53.089 and 1996 were not immunized. 00:11:53.089 --> 00:11:56.048 The rate of whooping cough has also been increasing 00:11:56.048 --> 00:11:58.004 for the past 20 years. 00:11:58.004 --> 00:12:00.089 From less than one in 100,000 00:12:00.089 --> 00:12:04.025 to 18 per 100,000 here in California. 00:12:04.025 --> 00:12:08.058 And in some California counties such as San Luis Obispo, 00:12:08.058 --> 00:12:12.087 rates are nearly as high as before vaccines were developed. 00:12:12.087 --> 00:12:14.090 Two days after our interview 00:12:14.090 --> 00:12:18.062 with the Bryce family, Matthew got a fever. 00:12:18.062 --> 00:12:21.048 He was hospitalized at Rady's Children's Hospital 00:12:21.048 --> 00:12:24.000 in San Diego. 00:12:24.000 --> 00:12:26.082 Matthew was not immunized against whooping cough. 00:12:26.082 --> 00:12:28.005 He's too young. 00:12:28.005 --> 00:12:31.089 Babies can't be immunized until they're two months old. 00:12:31.089 --> 00:12:34.087 But everyone else in the Bryce family was vaccinated - 00:12:34.087 --> 00:12:37.015 even his parents got booster shots. 00:12:37.015 --> 00:12:39.039 The practice of immunizing everyone 00:12:39.039 --> 00:12:42.002 around a newborn baby is called cocooning. 00:12:42.002 --> 00:12:46.086 CINDY BRYCE: When I called the doctor they asked me who has it 00:12:46.086 --> 00:12:50.038 and I couldn't give them an answer because I don't know 00:12:50.038 --> 00:12:53.046 where he got it from because everyone's been vaccinated. 00:12:53.046 --> 00:12:56.054 FARYON: Myron and one of his sons were also tested 00:12:56.054 --> 00:12:58.038 for whooping cough - both were negative. 00:12:58.038 --> 00:13:00.099 M. BRYCE: The one thing I would want 00:13:00.099 --> 00:13:05.074 to know is the vaccine working? 00:13:05.074 --> 00:13:11.029 Is it as effective because before this I thought the 00:13:11.029 --> 00:13:18.071 vaccine was working and I thought that if I did everything 00:13:18.071 --> 00:13:27.022 that I was told to do that our sons would be protected. 00:13:27.022 --> 00:13:30.013 FARYON: Just how effective is the vaccine? 00:13:30.013 --> 00:13:32.070 That all depends on who you talk to. 00:13:32.070 --> 00:13:34.025 Drug information included 00:13:34.025 --> 00:13:37.011 with the two most commonly used whooping cough vaccines 00:13:37.011 --> 00:13:40.040 in the US say the vaccine is 85 percent effective. 00:13:40.040 --> 00:13:44.012 MOOI: This new strain has completely invaded the 00:13:44.012 --> 00:13:46.049 Netherlands and also other countries and pushed 00:13:46.049 --> 00:13:48.028 out all the other strains. 00:13:48.028 --> 00:13:49.009 It's quite unique. 00:13:49.009 --> 00:13:51.065 FARYON: Dr. Mooi believes there's no way 00:13:51.065 --> 00:13:54.048 to determine how effective the vaccines are 00:13:54.048 --> 00:13:56.012 because they have not been tested 00:13:56.012 --> 00:13:58.038 against the new strain of whooping cough. 00:13:58.038 --> 00:13:59.074 MOOI: We call it the p3 strain. 00:13:59.074 --> 00:14:02.054 FARYON: A strain he believes is more virulent 00:14:02.054 --> 00:14:04.000 and can make people sicker. 00:14:04.000 --> 00:14:07.053 This strain emerged while the new acellular vaccines were 00:14:07.053 --> 00:14:08.037 being developed. 00:14:08.037 --> 00:14:09.050 MOOI: I can tell you one 00:14:09.050 --> 00:14:14.032 of the reasons the vaccine companies are not too happy 00:14:14.032 --> 00:14:20.075 with me is because if what I say is true they selected the wrong 00:14:20.075 --> 00:14:22.098 strains in the 1980's. 00:14:22.098 --> 00:14:25.044 FARYON: Mooi's lab was studying the new strain 00:14:25.044 --> 00:14:28.062 when The Netherlands experienced an unexpected whooping cough 00:14:28.062 --> 00:14:30.026 epidemic in 1996. 00:14:31.005 --> 00:14:33.014 MOOI: There was a very direct relationship 00:14:33.014 --> 00:14:37.069 between the emergence of these strains, we call them p3 strains 00:14:37.069 --> 00:14:40.063 and the increase in pertussis notifications. 00:14:40.063 --> 00:14:44.082 CHERRY: There's absolutely no evidence that either 00:14:44.082 --> 00:14:48.087 of the two vaccines that are most common today used 00:14:48.087 --> 00:14:54.033 in the U.S. that there is increased vaccine failure 00:14:54.033 --> 00:14:56.001 with either of those vaccines. 00:14:56.001 --> 00:15:01.012 FARYON: So if you had to explain why we're seeing this epidemic 00:15:01.012 --> 00:15:03.008 the highest number of cases in 60 years, 00:15:03.008 --> 00:15:04.069 what would you tell people? 00:15:04.069 --> 00:15:07.055 CHERRY: The main reason is increased awareness. 00:15:07.055 --> 00:15:12.050 People, particularly public health people are much more 00:15:12.050 --> 00:15:14.088 aware and that trickles down. 00:15:14.088 --> 00:15:17.055 FARYON: Cherry says the increase is also due in part 00:15:17.055 --> 00:15:19.088 because of something called waning immunity. 00:15:19.088 --> 00:15:23.050 Immunity to whooping cough does not last a lifetime, 00:15:23.050 --> 00:15:26.044 whether you are vaccinated or develop natural immunity 00:15:26.044 --> 00:15:27.096 from getting the disease. 00:15:27.096 --> 00:15:31.059 Almost all experts agree waning immunity is contributing 00:15:31.059 --> 00:15:34.035 to whooping cough outbreaks worldwide. 00:15:34.035 --> 00:15:38.057 Where they disagree: when does immunity fail? 00:15:41.006 --> 00:15:45.029 Dr. Mooi believes the new strain of Pertussis causes immunity 00:15:45.029 --> 00:15:47.039 to fail sooner than in the past. 00:15:47.039 --> 00:15:49.017 And he's published his findings 00:15:49.017 --> 00:15:52.050 in several peer reviewed journals including the CDC's 00:15:52.050 --> 00:15:54.000 Infectious Diseases. 00:15:54.000 --> 00:15:59.027 MOOI: When the immunity is sub-optimal what will happen the 00:15:59.027 --> 00:16:04.029 bacteria will not be recognized very well by the immune system 00:16:04.029 --> 00:16:08.033 because of the mismatch and second of all even 00:16:08.033 --> 00:16:10.071 if immune response is started 00:16:10.071 --> 00:16:14.074 in the body the toxin will be able to delay it. 00:16:14.074 --> 00:16:19.091 You could say these two changes work together 00:16:19.091 --> 00:16:22.046 by decreasing the period 00:16:22.046 --> 00:16:25.083 of which the vaccine is protective further. 00:16:25.083 --> 00:16:27.089 FARYON: The Netherlands learned something else 00:16:27.089 --> 00:16:30.035 after its 1996 epidemic. 00:16:30.035 --> 00:16:33.032 At the time, it had very few samples of the bacteria 00:16:33.032 --> 00:16:35.085 that was causing people to get sick. 00:16:35.085 --> 00:16:38.078 So Mooi's lab began asking doctors and their labs 00:16:38.078 --> 00:16:41.046 to send him positive Pertussis swabs. 00:16:41.046 --> 00:16:44.070 His lab now has 3,000 samples. 00:16:44.070 --> 00:16:47.091 California has collected just 29 samples from the more 00:16:47.091 --> 00:16:51.054 than 7,000 whooping cough cases in the state. 00:16:51.054 --> 00:16:55.008 During the KPBS/Watchdog four month investigation, 00:16:55.008 --> 00:16:57.016 we also learned data kept by the state 00:16:57.016 --> 00:17:00.088 and the CDC was often lagging behind county data 00:17:00.088 --> 00:17:02.070 and was inconsistent. 00:17:02.070 --> 00:17:05.085 While counties like San Diego knew the immunization status 00:17:05.085 --> 00:17:08.053 of the vast majority of people with whooping cough, 00:17:08.053 --> 00:17:11.076 the state's data listed the information as unknown. 00:17:11.076 --> 00:17:15.018 Despite statewide protocols for reporting pertussis, 00:17:15.018 --> 00:17:19.023 a KPBS/Watchdog survey found some counties don't follow them 00:17:19.023 --> 00:17:22.014 or are slow to report the information HORTON: 00:17:22.014 --> 00:17:24.093 There's a perception that the more numbers the better, 00:17:24.093 --> 00:17:30.046 but let me be very clear we in no way need reports 00:17:30.046 --> 00:17:33.004 on every single case of pertussis for us 00:17:33.004 --> 00:17:37.003 to make important judgments and decisions 00:17:37.003 --> 00:17:38.032 about what's happening. 00:17:38.032 --> 00:17:41.049 FARYON: The CDC in Atlanta declined our requests 00:17:41.049 --> 00:17:42.056 for an interview. 00:17:42.056 --> 00:17:45.048 In an email response they said it is "difficult 00:17:45.048 --> 00:17:49.038 to disentangle all the factors" contributing to increases 00:17:49.038 --> 00:17:52.086 in pertussis, but listed "increasing transmission, 00:17:52.086 --> 00:17:54.035 better recognition, 00:17:54.035 --> 00:17:57.029 and increased laboratory confirmation." 00:17:57.029 --> 00:18:00.029 We also asked whether a new more virulent strain could be 00:18:00.029 --> 00:18:02.005 contributing to the outbreak. 00:18:02.005 --> 00:18:05.078 The CDC's response: "Available data do not suggest 00:18:05.078 --> 00:18:08.034 that ptxP3 is more virulent, 00:18:08.034 --> 00:18:11.042 or that increasing reports are attributable only 00:18:11.042 --> 00:18:14.026 to the emergence of ptxP3. 00:18:14.026 --> 00:18:18.035 We continue to work on this and other potential explanations 00:18:18.035 --> 00:18:20.046 for the increase in pertussis 00:18:20.046 --> 00:18:23.077 that has occurred since the 1980s." 00:18:23.077 --> 00:18:26.094 The CDC sent us this study by their own investigators. 00:18:26.094 --> 00:18:28.018 The study looked at children 00:18:28.018 --> 00:18:30.095 between 6 months and five years old. 00:18:30.095 --> 00:18:33.007 It found pertussis vaccines to be more 00:18:33.007 --> 00:18:35.024 than 90 percent effective. 00:18:35.024 --> 00:18:39.059 The study looked at data between 1998 and 2001. 00:18:39.059 --> 00:18:42.071 It did not collect pertussis strain information. 00:18:42.071 --> 00:18:46.084 SINGING: Do you happen to know what a T-dap is? 00:18:46.084 --> 00:18:51.082 It's a special vaccine but it's not just for kids. 00:18:53.025 --> 00:18:55.094 FARYON: Sanofi Pastuer, one of two companies 00:18:55.094 --> 00:18:59.035 that make the vaccine widely used in the U.S., 00:18:59.035 --> 00:19:02.032 sponsored this singing competition earlier this year. 00:19:02.032 --> 00:19:07.006 SINGING: Pertussis is the reason why you should call your 00:19:07.006 --> 00:19:09.000 doctor today. 00:19:09.000 --> 00:19:11.041 FARYON: It was a public relations exercise 00:19:11.041 --> 00:19:15.003 to get the word out about whooping cough and immunization. 00:19:15.003 --> 00:19:18.031 But just where is the line between good PR and trying 00:19:18.031 --> 00:19:20.075 to influence public health policy? 00:19:20.075 --> 00:19:23.099 SINGING: Take a shot and give pertussis a whooping. 00:19:23.099 --> 00:19:28.070 FARYON: Especially when public health policy can increase 00:19:28.070 --> 00:19:30.014 vaccine sales. 00:19:30.014 --> 00:19:33.003 Since 2007, the California department 00:19:33.003 --> 00:19:36.002 of health has spent more than $200 million 00:19:36.002 --> 00:19:39.043 on pertussis vaccines for children on medical 00:19:39.043 --> 00:19:41.005 or who are under-insured. 00:19:41.005 --> 00:19:43.050 And it's sure to rise. 00:19:43.050 --> 00:19:47.083 In September, the California state legislature passed a law 00:19:47.083 --> 00:19:50.080 requiring all students to receive another dose, 00:19:50.080 --> 00:19:54.020 a sixth dose of the pertussis vaccine before entering 00:19:54.020 --> 00:19:55.035 middle school. 00:19:55.035 --> 00:19:57.010 It may be a case of what's good 00:19:57.010 --> 00:19:59.084 for business is also good for public health. 00:19:59.084 --> 00:20:02.033 But how much influence does industry have 00:20:02.033 --> 00:20:04.015 over public health policy? 00:20:04.015 --> 00:20:06.047 Sanofi Pasteur also established 00:20:06.047 --> 00:20:09.039 and funds The Global Pertussis Initiative. 00:20:09.039 --> 00:20:13.033 A group made up of medical experts from around the world. 00:20:13.033 --> 00:20:15.072 The GPI was established 10 years ago 00:20:15.072 --> 00:20:19.098 to study why pertussis was making a comeback and find ways 00:20:19.098 --> 00:20:21.054 to control the disease. 00:20:21.054 --> 00:20:23.033 More than half its members are employees 00:20:23.033 --> 00:20:25.004 of the pharmaceutical company 00:20:25.004 --> 00:20:28.017 or receive research money or consulting fees. 00:20:28.017 --> 00:20:31.046 Public officials from across the country, including California 00:20:31.046 --> 00:20:34.088 and the CDC, site the Global Pertussis Initiative 00:20:34.088 --> 00:20:37.021 when making vaccine policy. 00:20:37.021 --> 00:20:40.014 Dr. James Cherry is a member of the initiative. 00:20:40.014 --> 00:20:43.024 He's also received speaking fees and research funds 00:20:43.024 --> 00:20:45.031 from vaccine manufacturers. 00:20:45.031 --> 00:20:48.007 At the same time, he sat on government committees 00:20:48.007 --> 00:20:51.042 to help determine vaccine policy and efficacy. 00:20:51.042 --> 00:20:56.045 FARYON: A cynic might say that if you have a community 00:20:56.045 --> 00:21:01.025 of experts in pertussis as in the Global Pertussis Initiative, 00:21:01.025 --> 00:21:03.094 who primarily their work in terms 00:21:03.094 --> 00:21:06.036 of this endeavor is being funded by the drug company 00:21:06.036 --> 00:21:10.011 that makes the vaccine, there might be less incentive 00:21:10.011 --> 00:21:13.080 to say make a new vaccine and more incentive 00:21:13.080 --> 00:21:16.041 to say just use the old one more often. 00:21:16.041 --> 00:21:17.083 What do you say to them? 00:21:17.083 --> 00:21:19.092 CHERRY: I don't think that's true. 00:21:19.092 --> 00:21:25.050 I think that we've been talking about new vaccines. 00:21:25.050 --> 00:21:32.049 It think the difficulty with the new vaccine lies in the expense 00:21:32.049 --> 00:21:39.042 that it would cost to make a new vaccine and the difficulty 00:21:39.042 --> 00:21:46.003 in testing it because of FDA requirements for it and I think 00:21:46.003 --> 00:21:48.088 if the climate was right for either of two 00:21:48.088 --> 00:21:52.026 of the major manufacturers they would do it. 00:21:52.026 --> 00:21:55.048 MOOI: And these are three different pertussis strains. 00:21:55.048 --> 00:21:59.022 FARYON: Dr. Mooi is a critic of the Pertussis Initiative. 00:21:59.022 --> 00:22:04.063 MOOI: My big disappointment is they have totally 00:22:04.063 --> 00:22:09.008 and I think willfully ignored pathogen adaptation. 00:22:09.008 --> 00:22:15.050 I think a few years ago we had the year 00:22:15.050 --> 00:22:21.010 that Darwin died 100 year ago, it was not so long ago, 00:22:21.010 --> 00:22:25.046 I think it's very strange that evolution 00:22:25.046 --> 00:22:29.018 and pathogen adaptation is completely ignored 00:22:29.018 --> 00:22:30.020 by such a group. 00:22:30.020 --> 00:22:35.005 I find that bad for science and bad for public health. 00:22:35.005 --> 00:22:38.014 FARYON: Sanofi Pasteur released this statement to KPBS 00:22:38.014 --> 00:22:40.030 and the Watchdog Institute. 00:22:40.030 --> 00:22:44.015 It says its grant to the GPI brings the world's authorities 00:22:44.015 --> 00:22:48.050 on pertussis together and that benefits society as a whole. 00:22:48.050 --> 00:22:50.093 The company also says "at the present time, 00:22:50.093 --> 00:22:54.085 there is no evidence to suggest current pertussis vaccines 00:22:54.085 --> 00:22:56.079 lack effectiveness." 00:22:56.079 --> 00:23:00.064 Dr. Dean Sidelinger was one of the first health officials 00:23:00.064 --> 00:23:03.076 to learn immunized people were getting sick in his county. 00:23:03.076 --> 00:23:06.077 He said he was surprised, but in the end, 00:23:06.077 --> 00:23:10.075 he says the current vaccine is still the best thing he's got 00:23:10.075 --> 00:23:12.027 to protect his community. 00:23:12.027 --> 00:23:14.008 SIDELINGER: It does significantly decrease the 00:23:14.008 --> 00:23:17.000 pertussis we see a significantly lower number 00:23:17.000 --> 00:23:20.019 of pertussis cases now then we saw before we started using 00:23:20.019 --> 00:23:21.027 the vaccine. 00:23:21.027 --> 00:23:25.004 So we don't want people to feel complacent or to say I don't want 00:23:25.004 --> 00:23:27.033 that vaccine because I've seen many of the cases 00:23:27.033 --> 00:23:29.080 that have been reported were fully vaccinated. 00:23:29.080 --> 00:23:32.043 FARYON: Sidelinger says there would be many more cases 00:23:32.043 --> 00:23:34.070 if there was no vaccine at all. 00:23:34.070 --> 00:23:36.003 Dr. Mooi agrees. 00:23:36.003 --> 00:23:38.096 He believes public health officials should be encouraging 00:23:38.096 --> 00:23:43.050 cocooning, immunizing all those around newborn babies. 00:23:43.050 --> 00:23:48.094 But in the long run he says, we need better vaccines. 00:23:48.094 --> 00:23:51.079 Baby Matthew spent four days in the hospital 00:23:51.079 --> 00:23:54.025 and was eventually discharged. 00:23:54.025 --> 00:23:57.040 Today, he's getting his two-month routine check-up. 00:23:57.040 --> 00:24:00.009 DOCTOR: I think it was just bad luck he's had two illnesses 00:24:00.009 --> 00:24:04.050 in a row and now the cold he's building up his immunity. 00:24:04.050 --> 00:24:08.016 FARYON: Despite a stuffy nose, Matthew is doing well today. 00:24:08.016 --> 00:24:11.026 DCOTOR: As you might know the vaccine is not 00:24:11.026 --> 00:24:13.016 as effective as we want it to be. 00:24:13.016 --> 00:24:17.021 And that's one reason why there've been a lot of cases going around. 00:24:17.021 --> 00:24:21.052 But with Matthew in particular, his own immunity has kicked in 00:24:21.052 --> 00:24:24.069 from having the illness, that is, in effect a sort 00:24:24.069 --> 00:24:27.051 of a booster that will protect him going forward. 00:24:27.051 --> 00:24:31.032 And how long that immunity lasts is still a question. 00:24:31.071 --> 00:24:34.093 MARLON: The one thing I would want to say to parents is just ... 00:24:36.056 --> 00:24:39.034 is just watch your kids ... 00:24:39.040 --> 00:24:40.076 just be ... 00:24:45.000 --> 00:24:47.038 just be concerned. 00:24:47.038 --> 00:24:50.070 Because at first we thought we were being over protective. 00:24:51.062 --> 00:24:57.035 But I'm glad we were just a little bit over-concerned. 00:24:57.035 --> 00:25:00.091 FARYON: Since KPBS and the Watchdog Institute began its 00:25:00.091 --> 00:25:04.053 investigation, state health officials, the CDC 00:25:04.053 --> 00:25:08.016 and scientists from UCLA, including Dr. James Cherry, 00:25:08.016 --> 00:25:11.058 began a new study to determine whether the new strain 00:25:11.058 --> 00:25:13.045 of pertussis is contributing 00:25:13.045 --> 00:25:15.099 to the current whooping cough outbreak. 00:25:15.099 --> 00:25:18.060 For more on this story, and to see more of the data collected 00:25:18.060 --> 00:25:24.036 in our investigation, go to kpbs.org/whoopingcough 00:25:24.036 --> 00:25:27.075 and watchdoginstitute.org. 00:25:27.075 --> 00:25:30.021 For KPBS, the Watchdog Institute 00:25:30.021 --> 00:25:33.041 and Radio Netherlands Worldwide, I'm Joanne Faryon. 00:25:33.041 --> 00:25:35.091 Thanks for watching.