1 00:00:09,097 --> 00:00:12,022 Hello, Saya Joanne Faryon. 2 00:00:12,022 --> 00:00:15,060 Selamat datang di acara khusus malam ini. Ketika Kekebalan Tubuh Gagal: Epidemik Batuk Pertussis. 3 00:00:17,078 --> 00:00:21,055 Kita akan mendalami batuk pertussis terparah yang merajalela di California 4 00:00:21,055 --> 00:00:23,051 dalam 60 tahun ini. 5 00:00:23,051 --> 00:00:26,089 Mengapakah penyakit yang hampir punah 30 tahun yang lalu ini, 6 00:00:26,089 --> 00:00:30,092 kini kembali lagi, dan yang lebih parah 7 00:00:30,092 --> 00:00:32,046 menyerang ke seluruh negara di dunia? 8 00:00:32,046 --> 00:00:34,078 Apa yang kami temukan mungkin akan mengagetkan. 9 00:00:34,078 --> 00:00:37,064 Pertanyaan serius tentang seberapa kuatkah vaksin 10 00:00:37,064 --> 00:00:39,089 dapat mencegah penyebarluasan penyakit 11 00:00:39,089 --> 00:00:42,031 pertanyaan-pertanyaan resmi ke departemen kesehatan 12 00:00:42,031 --> 00:00:44,013 yang lamban direspon. 13 00:00:44,013 --> 00:00:47,021 KBPS bergabung bersama Watchdog Institute, 14 00:00:47,021 --> 00:00:48,096 sebuah pusat investigasi jurnalisme 15 00:00:48,096 --> 00:00:51,022 di Universitas San Diego, 16 00:00:51,022 --> 00:00:54,045 dan jaringan Radio Netherlands Worldwide untuk mengungkap kisah ini. 17 00:00:54,045 --> 00:00:57,000 Kisah yang membawa kita melintasi California 18 00:00:57,000 --> 00:00:59,063 hingga ke Amsterdam. 19 00:00:59,063 --> 00:01:02,036 But first, we begin in a delivery room 20 00:01:02,036 --> 00:01:06,060 in a San Diego hospital, where a mother has just given birth 21 00:01:06,060 --> 00:01:08,030 to her third son. 22 00:01:08,030 --> 00:01:15,014 [ baby crying ] 23 00:01:15,014 --> 00:01:19,018 Matthew Jacob Bryce was born Oct 11, 2010. 24 00:01:19,018 --> 00:01:23,070 A healthy baby, the third boy for Cindy and Marlon Bryce. 25 00:01:23,070 --> 00:01:25,076 Matthew started showing signs of a cold 26 00:01:25,076 --> 00:01:27,045 when he was just two weeks old. 27 00:01:27,045 --> 00:01:29,073 The Bryce family knew something was wrong. 28 00:01:29,073 --> 00:01:31,034 MARLON BRYCE: It just seemed 29 00:01:31,034 --> 00:01:35,064 like this cold it was just affecting his breathing. 30 00:01:35,064 --> 00:01:38,070 FARYON: The family was aware of the whooping cough epidemic 31 00:01:38,070 --> 00:01:40,054 in California, from news reports REPORTER: 32 00:01:40,054 --> 00:01:43,012 State health officials say more than 6,400 cases 33 00:01:43,012 --> 00:01:44,092 of whooping cough have been reported this year. 34 00:01:44,092 --> 00:01:46,070 FARYON: And their pediatrician. 35 00:01:46,070 --> 00:01:48,029 BRYCE: There wasn't any whooping 36 00:01:48,029 --> 00:01:52,051 or they always say there is a whooping or a cough, 37 00:01:52,051 --> 00:01:54,048 he didn't have a cough or anything it was just 38 00:01:54,048 --> 00:01:55,043 that there was a cold. 39 00:01:55,043 --> 00:01:58,062 FARYON: Matthew's doctor suspected it could be whooping 40 00:01:58,062 --> 00:02:00,081 cough, also known as Pertussis. 41 00:02:00,081 --> 00:02:03,067 She took a nasal swab and sent it to the lab. 42 00:02:03,067 --> 00:02:06,050 She also started Matthew on antibiotics. 43 00:02:06,050 --> 00:02:09,096 Six days later, with Matthew just 23 days old, 44 00:02:09,096 --> 00:02:11,037 Cindy Bryce got a phone call 45 00:02:11,037 --> 00:02:13,047 from the California Department of Health. 46 00:02:13,047 --> 00:02:15,093 The diagnosis was whooping cough. 47 00:02:15,093 --> 00:02:20,086 M. BRYCE: The moment I heard it I just immediately started 48 00:02:20,086 --> 00:02:26,005 thinking the worst because you have heard the news 49 00:02:26,005 --> 00:02:28,068 about the babies that have passed away. 50 00:02:28,068 --> 00:02:31,077 FARYON: From January to October this year, 51 00:02:31,077 --> 00:02:35,006 10 newborns in California died from whooping cough, 52 00:02:35,006 --> 00:02:37,015 two in San Diego County. 53 00:02:37,015 --> 00:02:40,044 More than 7,000 children and adults got sick 54 00:02:40,044 --> 00:02:43,037 from the disease - the highest number in the state 55 00:02:43,037 --> 00:02:45,019 in more than 60 years. 56 00:02:45,019 --> 00:02:48,087 Just how did Matthew and so many others come down with a disease 57 00:02:48,087 --> 00:02:51,096 that is supposed to be preventable with a vaccine? 58 00:02:51,096 --> 00:02:53,096 Tonight we'll raise questions 59 00:02:53,096 --> 00:02:56,090 about the effectiveness of that vaccine. 60 00:02:56,090 --> 00:03:01,040 A four-month investigation by KPBS and the Watchdog Institute, 61 00:03:01,040 --> 00:03:03,086 found many people who have been diagnosed 62 00:03:03,086 --> 00:03:07,013 with whooping cough were immunized. 63 00:03:07,013 --> 00:03:09,090 We also show how government data on the number 64 00:03:09,090 --> 00:03:13,034 of people diagnosed with whooping cough lacks timeliness 65 00:03:13,034 --> 00:03:16,068 and is often inconsistent, begging the question: 66 00:03:16,068 --> 00:03:19,059 just who is keeping track of this epidemic? 67 00:03:19,059 --> 00:03:21,065 We'll show you how some of the experts 68 00:03:21,065 --> 00:03:25,021 who influence vaccine policy are financially tied 69 00:03:25,021 --> 00:03:27,003 to vaccine companies. 70 00:03:27,003 --> 00:03:29,038 And, we'll follow the Bryce family as they struggle 71 00:03:29,038 --> 00:03:33,082 with their son's diagnosis, and the setbacks in his recovery. 72 00:03:36,092 --> 00:03:40,063 Whooping cough, violent cough, the hundred-day cough; 73 00:03:40,063 --> 00:03:42,037 all names for Pertussis. 74 00:03:42,037 --> 00:03:44,091 DR. JAMES CHERRY: What causes the cough actually we 75 00:03:44,091 --> 00:03:45,068 don't know... 76 00:03:45,068 --> 00:03:47,044 there's no other cough quite like it. 77 00:03:47,044 --> 00:03:50,084 FARYON: Pertussis is a respiratory illness caused 78 00:03:50,084 --> 00:03:53,043 by the bacterium Bordetella pertussis. 79 00:03:53,043 --> 00:03:55,053 At first, it can mimic a cold. 80 00:03:55,053 --> 00:03:59,006 But later produces a violent and persistent cough, 81 00:03:59,006 --> 00:04:02,009 a cough that leaves children gasping for air - 82 00:04:02,009 --> 00:04:05,019 creating the distinct whooping sound. 83 00:04:05,019 --> 00:04:08,037 For adults, whooping cough may only be a nuisance. 84 00:04:08,037 --> 00:04:11,025 In fact scientists estimate more than 80 percent 85 00:04:11,025 --> 00:04:14,012 of adult cases are never diagnosed 86 00:04:14,012 --> 00:04:17,025 because most people assume they just have a bad cold. 87 00:04:17,025 --> 00:04:20,050 But to infants whooping cough can be deadly, 88 00:04:20,050 --> 00:04:22,094 especially if not diagnosed early. 89 00:04:22,094 --> 00:04:25,038 DR. JAMES CHERRY: So with infection 90 00:04:25,038 --> 00:04:29,085 that you eventually clear the bacteria and you get better. 91 00:04:29,085 --> 00:04:34,047 But it's a prolonged, most cases ... 92 00:04:34,047 --> 00:04:37,036 a good percentage of cases in children 93 00:04:37,036 --> 00:04:39,062 will last for one or two months. 94 00:04:39,062 --> 00:04:41,068 DR. FRITS MOOI: After a pertussis infection 95 00:04:41,068 --> 00:04:45,003 you often get super infections, actually that is one 96 00:04:45,003 --> 00:04:47,008 of the main complications, pneumonia. 97 00:04:47,008 --> 00:04:50,024 FARYON: Young babies aren't able to cough up secretions 98 00:04:50,024 --> 00:04:52,061 that collect in their lungs, leading to pneumonia 99 00:04:52,061 --> 00:04:54,093 and making it difficult to breathe. 100 00:04:54,093 --> 00:04:59,049 Early antibiotic treatment is most critical in this age group. 101 00:04:59,049 --> 00:05:02,062 Whooping cough was nearly wiped out by the late 1970's 102 00:05:02,062 --> 00:05:04,091 because of mass immunization, 103 00:05:04,091 --> 00:05:07,039 but it's somehow found its way back to California 104 00:05:07,039 --> 00:05:11,029 and other highly vaccinated communities around the world. 105 00:05:11,029 --> 00:05:14,006 Just why it's made such a vengeful comeback has two 106 00:05:14,006 --> 00:05:17,057 of the world's leading whooping cough experts in disagreement. 107 00:05:17,057 --> 00:05:20,026 Dr. James Cherry of UCLA: CHERRY: 108 00:05:20,026 --> 00:05:22,052 The main reason is increased awareness. 109 00:05:22,052 --> 00:05:25,012 FARYON: and Dr. Frits Mooi of the Netherlands Centre 110 00:05:25,012 --> 00:05:26,094 for Infectious Diseases Control. 111 00:05:26,094 --> 00:05:33,035 MOOI: We found really a new mutation in the bug. 112 00:05:33,035 --> 00:05:37,012 FARYON: Dr. Mooi and Dr. Cherry both began their research 113 00:05:37,012 --> 00:05:39,075 into Whooping Cough about 30 years ago. 114 00:05:39,075 --> 00:05:42,093 Cherry in the U.S. and Mooi in The Netherlands. 115 00:05:42,093 --> 00:05:45,062 The two scientists know each other's work. 116 00:05:45,062 --> 00:05:49,079 CHERRY: First of all, his molecular microbiological science is, 117 00:05:49,079 --> 00:05:54,099 he's right at the top of scholars. 118 00:05:54,099 --> 00:05:57,037 There's no question about that. 119 00:05:57,037 --> 00:06:02,014 I think where some of the things he's published is the clinical 120 00:06:02,014 --> 00:06:04,006 data are not very good. 121 00:06:04,006 --> 00:06:07,029 MOOI: I don't communicate too much with him but what he wrote 122 00:06:07,029 --> 00:06:11,058 in the press is that I screw up epidemiology. 123 00:06:11,058 --> 00:06:13,043 That doesn't help me too much. 124 00:06:13,043 --> 00:06:16,049 FARYON: To understand why these two experts disagree, 125 00:06:16,049 --> 00:06:18,056 you need to know a little about the history 126 00:06:18,056 --> 00:06:19,085 of the pertussis vaccine. 127 00:06:19,085 --> 00:06:23,070 ANNOUNCER: Since most serious cases occur before school age, 128 00:06:23,070 --> 00:06:26,012 immunization in school may be too late. 129 00:06:26,012 --> 00:06:29,033 FARYON: The bacteria that causes whooping cough was first 130 00:06:29,033 --> 00:06:32,010 isolated in Belgium in 1906. 131 00:06:32,010 --> 00:06:33,085 At the time, the illness was one 132 00:06:33,085 --> 00:06:35,069 of the leading causes of infant death. 133 00:06:35,069 --> 00:06:40,068 ANNOUNCER: In 1921, whooping cough killed 316 134 00:06:40,068 --> 00:06:42,056 Michigan children. 135 00:06:42,056 --> 00:06:47,031 Last year, the number of deaths was reduced to 63. 136 00:06:47,031 --> 00:06:51,033 FARYON: The discovery lead to the first attempts at a vaccine. 137 00:06:51,033 --> 00:06:55,025 But it wasn't until the late 1940's scientists developed a 138 00:06:55,025 --> 00:06:58,000 vaccine effective enough to prevent whooping cough. 139 00:06:58,000 --> 00:06:59,092 ANNOUNCER: Unlike the disease however, 140 00:06:59,092 --> 00:07:01,067 a vaccine does not endanger life. 141 00:07:01,067 --> 00:07:05,035 FARYON: By 1946, mass immunization programs began 142 00:07:05,035 --> 00:07:08,085 in the U.S. and the number of cases dropped dramatically. 143 00:07:08,085 --> 00:07:10,079 Prior to the vaccine the rate 144 00:07:10,079 --> 00:07:14,080 of disease was 157 cases per 100,000. 145 00:07:14,080 --> 00:07:19,081 By the 1970's, with large scale immunizations, fewer than one 146 00:07:19,081 --> 00:07:22,067 in one hundred thousand people got whooping cough. 147 00:07:22,067 --> 00:07:26,022 But the vaccine was not without controversy. 148 00:07:26,022 --> 00:07:29,033 The early versions were associated with side effects 149 00:07:29,033 --> 00:07:32,097 such as prolonged crying spells and seizures in babies. 150 00:07:32,097 --> 00:07:37,062 By 1996, the FDA approved a new whooping cough vaccine. 151 00:07:37,062 --> 00:07:40,017 It was called an acellular version. 152 00:07:40,017 --> 00:07:43,026 That means the vaccine uses only purified components 153 00:07:43,026 --> 00:07:45,062 of the disease-causing organism. 154 00:07:45,062 --> 00:07:49,007 That vaccine was considered to be safer and associated 155 00:07:49,007 --> 00:07:51,031 with few mild side effects. 156 00:07:51,031 --> 00:07:56,050 Today, the U.S. uses only the acellular pertussis vaccine. 157 00:07:59,040 --> 00:08:02,061 But as the United States was changing vaccines something else 158 00:08:02,061 --> 00:08:04,041 was happening 159 00:08:05,078 --> 00:08:09,074 health officials across the country were reporting increasing numbers 160 00:08:09,074 --> 00:08:12,016 of positive whooping cough cases. 161 00:08:12,016 --> 00:08:16,013 And in a government lab about 30 minutes outside of Amsterdam, 162 00:08:16,013 --> 00:08:19,018 a group of scientists had discovered something else - 163 00:08:19,018 --> 00:08:22,031 the bacterium that causes whooping cough started 164 00:08:22,031 --> 00:08:23,099 to look a little different. 165 00:08:23,099 --> 00:08:28,068 MOOI: This new mutation had the effect that the bacteria started 166 00:08:28,068 --> 00:08:30,051 to produce more pertussis toxin. 167 00:08:30,051 --> 00:08:32,079 FARYON: Just whether that mutation is to blame, 168 00:08:32,079 --> 00:08:35,049 at least in part, for the California epidemic 169 00:08:35,049 --> 00:08:38,035 and outbreaks elsewhere in the world is at the heart 170 00:08:38,035 --> 00:08:40,025 of the whooping cough debate. 171 00:08:40,025 --> 00:08:44,045 Dr. Mooi believes this to be the case, but not Dr. Cherry. 172 00:08:44,045 --> 00:08:47,023 CHERRY: Even though these changes have occurred there is 173 00:08:47,023 --> 00:08:51,011 no evidence that that's lead to increased vaccine failure. 174 00:08:56,024 --> 00:08:59,066 FARYON: Here in San Diego County, more than 85 percent 175 00:08:59,066 --> 00:09:01,039 of children are immunized. 176 00:09:01,039 --> 00:09:03,019 In fact, less than three percent 177 00:09:03,019 --> 00:09:06,086 of kids entering kindergarten have not been immunized 178 00:09:06,086 --> 00:09:09,007 because of their family's personal beliefs. 179 00:09:09,007 --> 00:09:11,076 But despite the high immunization rate, 180 00:09:11,076 --> 00:09:14,050 San Diego has the second largest number 181 00:09:14,050 --> 00:09:17,065 of positive whooping cough cases in California. 182 00:09:17,065 --> 00:09:20,075 Dr. Dean Sidelinger is San Diego's deputy public 183 00:09:20,075 --> 00:09:21,071 health officer. 184 00:09:21,071 --> 00:09:22,071 DR. DEAN SIDELINGER: This is a disease 185 00:09:22,071 --> 00:09:25,014 that if someone has it it's very easily transferred 186 00:09:25,014 --> 00:09:26,076 from one person to another. 187 00:09:26,076 --> 00:09:29,010 So if you or I sitting here during this interview, 188 00:09:29,010 --> 00:09:32,009 one of us had pertussis chances are we could transmit 189 00:09:32,009 --> 00:09:33,047 that to the other person. 190 00:09:33,047 --> 00:09:34,099 Sidelinger says in the past, 191 00:09:34,099 --> 00:09:37,099 the number of whooping cough cases peaked in summer 192 00:09:37,099 --> 00:09:41,069 and slowed by fall, but this year, that didn't happen. 193 00:09:41,069 --> 00:09:45,035 SIDELINGER: So as time goes on we're seeing more cases. 194 00:09:45,035 --> 00:09:48,095 We know that public awareness plays into that as we talk 195 00:09:48,095 --> 00:09:51,048 about Pertussis more people are asking their doctors 196 00:09:51,048 --> 00:09:53,023 and doctors are asking their patients we're going 197 00:09:53,023 --> 00:09:55,040 to see more, but that trend continued. 198 00:09:55,040 --> 00:09:59,052 FARYON: By the end of November 2010, nearly 1000 infants, 199 00:09:59,052 --> 00:10:02,083 children and adults in San Diego County tested positive 200 00:10:02,083 --> 00:10:04,004 for whooping cough. 201 00:10:04,004 --> 00:10:06,075 More than half of them had been immunized. 202 00:10:06,075 --> 00:10:08,009 Our investigation shows 203 00:10:08,009 --> 00:10:10,088 that trend continues throughout California. 204 00:10:10,088 --> 00:10:14,019 KPBS and The Watchdog Institute collected data 205 00:10:14,019 --> 00:10:16,095 from 9 California counties that report some 206 00:10:16,095 --> 00:10:19,004 of the highest infection rates. 207 00:10:19,004 --> 00:10:22,059 Our research shows that where immunization history is known, 208 00:10:22,059 --> 00:10:26,024 between 44 and 83 percent of people diagnosed 209 00:10:26,024 --> 00:10:28,064 with whooping cough were vaccinated. 210 00:10:28,064 --> 00:10:30,037 We looked at California Department 211 00:10:30,037 --> 00:10:32,042 of Public Health records too. 212 00:10:32,042 --> 00:10:35,046 In cases where vaccination history was recorded, 213 00:10:35,046 --> 00:10:39,009 more than 80 percent of infected people had been immunized. 214 00:10:39,009 --> 00:10:41,004 DR. MARK HORTON: From the epidemiology experts 215 00:10:41,004 --> 00:10:45,077 and the experts in vaccine this is absolutely expected. 216 00:10:45,077 --> 00:10:48,022 FARYON: Dr. Mark Horton is the director 217 00:10:48,022 --> 00:10:50,074 of the California Department of Public Health. 218 00:10:50,074 --> 00:10:52,055 HORTON: If you've got a percentage 219 00:10:52,055 --> 00:10:56,034 of the population vaccinated and a percentage of those vaccinated 220 00:10:56,034 --> 00:10:57,044 that are still susceptible 221 00:10:57,044 --> 00:11:00,082 because the vaccine isn't perfectly effective or effective 222 00:11:00,082 --> 00:11:02,079 in all individuals, when you work 223 00:11:02,079 --> 00:11:05,004 out the arithmetic you'll see that even 224 00:11:05,004 --> 00:11:06,098 with a very effective vaccine, 225 00:11:06,098 --> 00:11:08,036 and even if you have the majority 226 00:11:08,036 --> 00:11:10,029 of the population vaccinated, 227 00:11:10,029 --> 00:11:14,012 the pool of susceptibles will include a number of individuals 228 00:11:14,012 --> 00:11:15,038 that have never been vaccinated 229 00:11:15,038 --> 00:11:19,038 but will also include quite a few and in some cases greater 230 00:11:19,038 --> 00:11:20,024 than 50 percent 231 00:11:20,024 --> 00:11:22,035 of the individuals have been previously vaccinated. 232 00:11:22,035 --> 00:11:24,066 FARYON: In other words, if you do the math, 233 00:11:24,066 --> 00:11:26,072 you will always find a certain number 234 00:11:26,072 --> 00:11:28,062 of immunized people getting sick 235 00:11:28,062 --> 00:11:31,064 if a vaccine is not 100 percent effective. 236 00:11:31,064 --> 00:11:34,092 HORTON: So that's no surprise to us nor is it a reflection 237 00:11:34,092 --> 00:11:36,051 on the efficacy of the vaccine. 238 00:11:36,051 --> 00:11:37,088 REPORTER KEVIN CROWE: It's not a reflection 239 00:11:37,088 --> 00:11:39,007 on the efficacy of the vaccine? 240 00:11:39,007 --> 00:11:39,069 HORTON: Correct, correct. 241 00:11:39,069 --> 00:11:42,055 FARYON: But 20 years ago, the reverse was true. 242 00:11:42,055 --> 00:11:44,099 According to a report by the Centers for Disease Control, 243 00:11:44,099 --> 00:11:48,041 more than half of the children between 3 months and 4 years old 244 00:11:48,041 --> 00:11:51,045 who got whooping cough nationwide between 1990 245 00:11:51,045 --> 00:11:53,089 and 1996 were not immunized. 246 00:11:53,089 --> 00:11:56,048 The rate of whooping cough has also been increasing 247 00:11:56,048 --> 00:11:58,004 for the past 20 years. 248 00:11:58,004 --> 00:12:00,089 From less than one in 100,000 249 00:12:00,089 --> 00:12:04,025 to 18 per 100,000 here in California. 250 00:12:04,025 --> 00:12:08,058 And in some California counties such as San Luis Obispo, 251 00:12:08,058 --> 00:12:12,087 rates are nearly as high as before vaccines were developed. 252 00:12:12,087 --> 00:12:14,090 Two days after our interview 253 00:12:14,090 --> 00:12:18,062 with the Bryce family, Matthew got a fever. 254 00:12:18,062 --> 00:12:21,048 He was hospitalized at Rady's Children's Hospital 255 00:12:21,048 --> 00:12:24,000 in San Diego. 256 00:12:24,000 --> 00:12:26,082 Matthew was not immunized against whooping cough. 257 00:12:26,082 --> 00:12:28,005 He's too young. 258 00:12:28,005 --> 00:12:31,089 Babies can't be immunized until they're two months old. 259 00:12:31,089 --> 00:12:34,087 But everyone else in the Bryce family was vaccinated - 260 00:12:34,087 --> 00:12:37,015 even his parents got booster shots. 261 00:12:37,015 --> 00:12:39,039 The practice of immunizing everyone 262 00:12:39,039 --> 00:12:42,002 around a newborn baby is called cocooning. 263 00:12:42,002 --> 00:12:46,086 CINDY BRYCE: When I called the doctor they asked me who has it 264 00:12:46,086 --> 00:12:50,038 and I couldn't give them an answer because I don't know 265 00:12:50,038 --> 00:12:53,046 where he got it from because everyone's been vaccinated. 266 00:12:53,046 --> 00:12:56,054 FARYON: Myron and one of his sons were also tested 267 00:12:56,054 --> 00:12:58,038 for whooping cough - both were negative. 268 00:12:58,038 --> 00:13:00,099 M. BRYCE: The one thing I would want 269 00:13:00,099 --> 00:13:05,074 to know is the vaccine working? 270 00:13:05,074 --> 00:13:11,029 Is it as effective because before this I thought the 271 00:13:11,029 --> 00:13:18,071 vaccine was working and I thought that if I did everything 272 00:13:18,071 --> 00:13:27,022 that I was told to do that our sons would be protected. 273 00:13:27,022 --> 00:13:30,013 FARYON: Just how effective is the vaccine? 274 00:13:30,013 --> 00:13:32,070 That all depends on who you talk to. 275 00:13:32,070 --> 00:13:34,025 Drug information included 276 00:13:34,025 --> 00:13:37,011 with the two most commonly used whooping cough vaccines 277 00:13:37,011 --> 00:13:40,040 in the US say the vaccine is 85 percent effective. 278 00:13:40,040 --> 00:13:44,012 MOOI: This new strain has completely invaded the 279 00:13:44,012 --> 00:13:46,049 Netherlands and also other countries and pushed 280 00:13:46,049 --> 00:13:48,028 out all the other strains. 281 00:13:48,028 --> 00:13:49,009 It's quite unique. 282 00:13:49,009 --> 00:13:51,065 FARYON: Dr. Mooi believes there's no way 283 00:13:51,065 --> 00:13:54,048 to determine how effective the vaccines are 284 00:13:54,048 --> 00:13:56,012 because they have not been tested 285 00:13:56,012 --> 00:13:58,038 against the new strain of whooping cough. 286 00:13:58,038 --> 00:13:59,074 MOOI: We call it the p3 strain. 287 00:13:59,074 --> 00:14:02,054 FARYON: A strain he believes is more virulent 288 00:14:02,054 --> 00:14:04,000 and can make people sicker. 289 00:14:04,000 --> 00:14:07,053 This strain emerged while the new acellular vaccines were 290 00:14:07,053 --> 00:14:08,037 being developed. 291 00:14:08,037 --> 00:14:09,050 MOOI: I can tell you one 292 00:14:09,050 --> 00:14:14,032 of the reasons the vaccine companies are not too happy 293 00:14:14,032 --> 00:14:20,075 with me is because if what I say is true they selected the wrong 294 00:14:20,075 --> 00:14:22,098 strains in the 1980's. 295 00:14:22,098 --> 00:14:25,044 FARYON: Mooi's lab was studying the new strain 296 00:14:25,044 --> 00:14:28,062 when The Netherlands experienced an unexpected whooping cough 297 00:14:28,062 --> 00:14:30,026 epidemic in 1996. 298 00:14:31,005 --> 00:14:33,014 MOOI: There was a very direct relationship 299 00:14:33,014 --> 00:14:37,069 between the emergence of these strains, we call them p3 strains 300 00:14:37,069 --> 00:14:40,063 and the increase in pertussis notifications. 301 00:14:40,063 --> 00:14:44,082 CHERRY: There's absolutely no evidence that either 302 00:14:44,082 --> 00:14:48,087 of the two vaccines that are most common today used 303 00:14:48,087 --> 00:14:54,033 in the U.S. that there is increased vaccine failure 304 00:14:54,033 --> 00:14:56,001 with either of those vaccines. 305 00:14:56,001 --> 00:15:01,012 FARYON: So if you had to explain why we're seeing this epidemic 306 00:15:01,012 --> 00:15:03,008 the highest number of cases in 60 years, 307 00:15:03,008 --> 00:15:04,069 what would you tell people? 308 00:15:04,069 --> 00:15:07,055 CHERRY: The main reason is increased awareness. 309 00:15:07,055 --> 00:15:12,050 People, particularly public health people are much more 310 00:15:12,050 --> 00:15:14,088 aware and that trickles down. 311 00:15:14,088 --> 00:15:17,055 FARYON: Cherry says the increase is also due in part 312 00:15:17,055 --> 00:15:19,088 because of something called waning immunity. 313 00:15:19,088 --> 00:15:23,050 Immunity to whooping cough does not last a lifetime, 314 00:15:23,050 --> 00:15:26,044 whether you are vaccinated or develop natural immunity 315 00:15:26,044 --> 00:15:27,096 from getting the disease. 316 00:15:27,096 --> 00:15:31,059 Almost all experts agree waning immunity is contributing 317 00:15:31,059 --> 00:15:34,035 to whooping cough outbreaks worldwide. 318 00:15:34,035 --> 00:15:38,057 Where they disagree: when does immunity fail? 319 00:15:41,006 --> 00:15:45,029 Dr. Mooi believes the new strain of Pertussis causes immunity 320 00:15:45,029 --> 00:15:47,039 to fail sooner than in the past. 321 00:15:47,039 --> 00:15:49,017 And he's published his findings 322 00:15:49,017 --> 00:15:52,050 in several peer reviewed journals including the CDC's 323 00:15:52,050 --> 00:15:54,000 Infectious Diseases. 324 00:15:54,000 --> 00:15:59,027 MOOI: When the immunity is sub-optimal what will happen the 325 00:15:59,027 --> 00:16:04,029 bacteria will not be recognized very well by the immune system 326 00:16:04,029 --> 00:16:08,033 because of the mismatch and second of all even 327 00:16:08,033 --> 00:16:10,071 if immune response is started 328 00:16:10,071 --> 00:16:14,074 in the body the toxin will be able to delay it. 329 00:16:14,074 --> 00:16:19,091 You could say these two changes work together 330 00:16:19,091 --> 00:16:22,046 by decreasing the period 331 00:16:22,046 --> 00:16:25,083 of which the vaccine is protective further. 332 00:16:25,083 --> 00:16:27,089 FARYON: The Netherlands learned something else 333 00:16:27,089 --> 00:16:30,035 after its 1996 epidemic. 334 00:16:30,035 --> 00:16:33,032 At the time, it had very few samples of the bacteria 335 00:16:33,032 --> 00:16:35,085 that was causing people to get sick. 336 00:16:35,085 --> 00:16:38,078 So Mooi's lab began asking doctors and their labs 337 00:16:38,078 --> 00:16:41,046 to send him positive Pertussis swabs. 338 00:16:41,046 --> 00:16:44,070 His lab now has 3,000 samples. 339 00:16:44,070 --> 00:16:47,091 California has collected just 29 samples from the more 340 00:16:47,091 --> 00:16:51,054 than 7,000 whooping cough cases in the state. 341 00:16:51,054 --> 00:16:55,008 During the KPBS/Watchdog four month investigation, 342 00:16:55,008 --> 00:16:57,016 we also learned data kept by the state 343 00:16:57,016 --> 00:17:00,088 and the CDC was often lagging behind county data 344 00:17:00,088 --> 00:17:02,070 and was inconsistent. 345 00:17:02,070 --> 00:17:05,085 While counties like San Diego knew the immunization status 346 00:17:05,085 --> 00:17:08,053 of the vast majority of people with whooping cough, 347 00:17:08,053 --> 00:17:11,076 the state's data listed the information as unknown. 348 00:17:11,076 --> 00:17:15,018 Despite statewide protocols for reporting pertussis, 349 00:17:15,018 --> 00:17:19,023 a KPBS/Watchdog survey found some counties don't follow them 350 00:17:19,023 --> 00:17:22,014 or are slow to report the information HORTON: 351 00:17:22,014 --> 00:17:24,093 There's a perception that the more numbers the better, 352 00:17:24,093 --> 00:17:30,046 but let me be very clear we in no way need reports 353 00:17:30,046 --> 00:17:33,004 on every single case of pertussis for us 354 00:17:33,004 --> 00:17:37,003 to make important judgments and decisions 355 00:17:37,003 --> 00:17:38,032 about what's happening. 356 00:17:38,032 --> 00:17:41,049 FARYON: The CDC in Atlanta declined our requests 357 00:17:41,049 --> 00:17:42,056 for an interview. 358 00:17:42,056 --> 00:17:45,048 In an email response they said it is "difficult 359 00:17:45,048 --> 00:17:49,038 to disentangle all the factors" contributing to increases 360 00:17:49,038 --> 00:17:52,086 in pertussis, but listed "increasing transmission, 361 00:17:52,086 --> 00:17:54,035 better recognition, 362 00:17:54,035 --> 00:17:57,029 and increased laboratory confirmation." 363 00:17:57,029 --> 00:18:00,029 We also asked whether a new more virulent strain could be 364 00:18:00,029 --> 00:18:02,005 contributing to the outbreak. 365 00:18:02,005 --> 00:18:05,078 The CDC's response: "Available data do not suggest 366 00:18:05,078 --> 00:18:08,034 that ptxP3 is more virulent, 367 00:18:08,034 --> 00:18:11,042 or that increasing reports are attributable only 368 00:18:11,042 --> 00:18:14,026 to the emergence of ptxP3. 369 00:18:14,026 --> 00:18:18,035 We continue to work on this and other potential explanations 370 00:18:18,035 --> 00:18:20,046 for the increase in pertussis 371 00:18:20,046 --> 00:18:23,077 that has occurred since the 1980s." 372 00:18:23,077 --> 00:18:26,094 The CDC sent us this study by their own investigators. 373 00:18:26,094 --> 00:18:28,018 The study looked at children 374 00:18:28,018 --> 00:18:30,095 between 6 months and five years old. 375 00:18:30,095 --> 00:18:33,007 It found pertussis vaccines to be more 376 00:18:33,007 --> 00:18:35,024 than 90 percent effective. 377 00:18:35,024 --> 00:18:39,059 The study looked at data between 1998 and 2001. 378 00:18:39,059 --> 00:18:42,071 It did not collect pertussis strain information. 379 00:18:42,071 --> 00:18:46,084 SINGING: Do you happen to know what a T-dap is? 380 00:18:46,084 --> 00:18:51,082 It's a special vaccine but it's not just for kids. 381 00:18:53,025 --> 00:18:55,094 FARYON: Sanofi Pastuer, one of two companies 382 00:18:55,094 --> 00:18:59,035 that make the vaccine widely used in the U.S., 383 00:18:59,035 --> 00:19:02,032 sponsored this singing competition earlier this year. 384 00:19:02,032 --> 00:19:07,006 SINGING: Pertussis is the reason why you should call your 385 00:19:07,006 --> 00:19:09,000 doctor today. 386 00:19:09,000 --> 00:19:11,041 FARYON: It was a public relations exercise 387 00:19:11,041 --> 00:19:15,003 to get the word out about whooping cough and immunization. 388 00:19:15,003 --> 00:19:18,031 But just where is the line between good PR and trying 389 00:19:18,031 --> 00:19:20,075 to influence public health policy? 390 00:19:20,075 --> 00:19:23,099 SINGING: Take a shot and give pertussis a whooping. 391 00:19:23,099 --> 00:19:28,070 FARYON: Especially when public health policy can increase 392 00:19:28,070 --> 00:19:30,014 vaccine sales. 393 00:19:30,014 --> 00:19:33,003 Since 2007, the California department 394 00:19:33,003 --> 00:19:36,002 of health has spent more than $200 million 395 00:19:36,002 --> 00:19:39,043 on pertussis vaccines for children on medical 396 00:19:39,043 --> 00:19:41,005 or who are under-insured. 397 00:19:41,005 --> 00:19:43,050 And it's sure to rise. 398 00:19:43,050 --> 00:19:47,083 In September, the California state legislature passed a law 399 00:19:47,083 --> 00:19:50,080 requiring all students to receive another dose, 400 00:19:50,080 --> 00:19:54,020 a sixth dose of the pertussis vaccine before entering 401 00:19:54,020 --> 00:19:55,035 middle school. 402 00:19:55,035 --> 00:19:57,010 It may be a case of what's good 403 00:19:57,010 --> 00:19:59,084 for business is also good for public health. 404 00:19:59,084 --> 00:20:02,033 But how much influence does industry have 405 00:20:02,033 --> 00:20:04,015 over public health policy? 406 00:20:04,015 --> 00:20:06,047 Sanofi Pasteur also established 407 00:20:06,047 --> 00:20:09,039 and funds The Global Pertussis Initiative. 408 00:20:09,039 --> 00:20:13,033 A group made up of medical experts from around the world. 409 00:20:13,033 --> 00:20:15,072 The GPI was established 10 years ago 410 00:20:15,072 --> 00:20:19,098 to study why pertussis was making a comeback and find ways 411 00:20:19,098 --> 00:20:21,054 to control the disease. 412 00:20:21,054 --> 00:20:23,033 More than half its members are employees 413 00:20:23,033 --> 00:20:25,004 of the pharmaceutical company 414 00:20:25,004 --> 00:20:28,017 or receive research money or consulting fees. 415 00:20:28,017 --> 00:20:31,046 Public officials from across the country, including California 416 00:20:31,046 --> 00:20:34,088 and the CDC, site the Global Pertussis Initiative 417 00:20:34,088 --> 00:20:37,021 when making vaccine policy. 418 00:20:37,021 --> 00:20:40,014 Dr. James Cherry is a member of the initiative. 419 00:20:40,014 --> 00:20:43,024 He's also received speaking fees and research funds 420 00:20:43,024 --> 00:20:45,031 from vaccine manufacturers. 421 00:20:45,031 --> 00:20:48,007 At the same time, he sat on government committees 422 00:20:48,007 --> 00:20:51,042 to help determine vaccine policy and efficacy. 423 00:20:51,042 --> 00:20:56,045 FARYON: A cynic might say that if you have a community 424 00:20:56,045 --> 00:21:01,025 of experts in pertussis as in the Global Pertussis Initiative, 425 00:21:01,025 --> 00:21:03,094 who primarily their work in terms 426 00:21:03,094 --> 00:21:06,036 of this endeavor is being funded by the drug company 427 00:21:06,036 --> 00:21:10,011 that makes the vaccine, there might be less incentive 428 00:21:10,011 --> 00:21:13,080 to say make a new vaccine and more incentive 429 00:21:13,080 --> 00:21:16,041 to say just use the old one more often. 430 00:21:16,041 --> 00:21:17,083 What do you say to them? 431 00:21:17,083 --> 00:21:19,092 CHERRY: I don't think that's true. 432 00:21:19,092 --> 00:21:25,050 I think that we've been talking about new vaccines. 433 00:21:25,050 --> 00:21:32,049 It think the difficulty with the new vaccine lies in the expense 434 00:21:32,049 --> 00:21:39,042 that it would cost to make a new vaccine and the difficulty 435 00:21:39,042 --> 00:21:46,003 in testing it because of FDA requirements for it and I think 436 00:21:46,003 --> 00:21:48,088 if the climate was right for either of two 437 00:21:48,088 --> 00:21:52,026 of the major manufacturers they would do it. 438 00:21:52,026 --> 00:21:55,048 MOOI: And these are three different pertussis strains. 439 00:21:55,048 --> 00:21:59,022 FARYON: Dr. Mooi is a critic of the Pertussis Initiative. 440 00:21:59,022 --> 00:22:04,063 MOOI: My big disappointment is they have totally 441 00:22:04,063 --> 00:22:09,008 and I think willfully ignored pathogen adaptation. 442 00:22:09,008 --> 00:22:15,050 I think a few years ago we had the year 443 00:22:15,050 --> 00:22:21,010 that Darwin died 100 year ago, it was not so long ago, 444 00:22:21,010 --> 00:22:25,046 I think it's very strange that evolution 445 00:22:25,046 --> 00:22:29,018 and pathogen adaptation is completely ignored 446 00:22:29,018 --> 00:22:30,020 by such a group. 447 00:22:30,020 --> 00:22:35,005 I find that bad for science and bad for public health. 448 00:22:35,005 --> 00:22:38,014 FARYON: Sanofi Pasteur released this statement to KPBS 449 00:22:38,014 --> 00:22:40,030 and the Watchdog Institute. 450 00:22:40,030 --> 00:22:44,015 It says its grant to the GPI brings the world's authorities 451 00:22:44,015 --> 00:22:48,050 on pertussis together and that benefits society as a whole. 452 00:22:48,050 --> 00:22:50,093 The company also says "at the present time, 453 00:22:50,093 --> 00:22:54,085 there is no evidence to suggest current pertussis vaccines 454 00:22:54,085 --> 00:22:56,079 lack effectiveness." 455 00:22:56,079 --> 00:23:00,064 Dr. Dean Sidelinger was one of the first health officials 456 00:23:00,064 --> 00:23:03,076 to learn immunized people were getting sick in his county. 457 00:23:03,076 --> 00:23:06,077 He said he was surprised, but in the end, 458 00:23:06,077 --> 00:23:10,075 he says the current vaccine is still the best thing he's got 459 00:23:10,075 --> 00:23:12,027 to protect his community. 460 00:23:12,027 --> 00:23:14,008 SIDELINGER: It does significantly decrease the 461 00:23:14,008 --> 00:23:17,000 pertussis we see a significantly lower number 462 00:23:17,000 --> 00:23:20,019 of pertussis cases now then we saw before we started using 463 00:23:20,019 --> 00:23:21,027 the vaccine. 464 00:23:21,027 --> 00:23:25,004 So we don't want people to feel complacent or to say I don't want 465 00:23:25,004 --> 00:23:27,033 that vaccine because I've seen many of the cases 466 00:23:27,033 --> 00:23:29,080 that have been reported were fully vaccinated. 467 00:23:29,080 --> 00:23:32,043 FARYON: Sidelinger says there would be many more cases 468 00:23:32,043 --> 00:23:34,070 if there was no vaccine at all. 469 00:23:34,070 --> 00:23:36,003 Dr. Mooi agrees. 470 00:23:36,003 --> 00:23:38,096 He believes public health officials should be encouraging 471 00:23:38,096 --> 00:23:43,050 cocooning, immunizing all those around newborn babies. 472 00:23:43,050 --> 00:23:48,094 But in the long run he says, we need better vaccines. 473 00:23:48,094 --> 00:23:51,079 Baby Matthew spent four days in the hospital 474 00:23:51,079 --> 00:23:54,025 and was eventually discharged. 475 00:23:54,025 --> 00:23:57,040 Today, he's getting his two-month routine check-up. 476 00:23:57,040 --> 00:24:00,009 DOCTOR: I think it was just bad luck he's had two illnesses 477 00:24:00,009 --> 00:24:04,050 in a row and now the cold he's building up his immunity. 478 00:24:04,050 --> 00:24:08,016 FARYON: Despite a stuffy nose, Matthew is doing well today. 479 00:24:08,016 --> 00:24:11,026 DCOTOR: As you might know the vaccine is not 480 00:24:11,026 --> 00:24:13,016 as effective as we want it to be. 481 00:24:13,016 --> 00:24:17,021 And that's one reason why there've been a lot of cases going around. 482 00:24:17,021 --> 00:24:21,052 But with Matthew in particular, his own immunity has kicked in 483 00:24:21,052 --> 00:24:24,069 from having the illness, that is, in effect a sort 484 00:24:24,069 --> 00:24:27,051 of a booster that will protect him going forward. 485 00:24:27,051 --> 00:24:31,032 And how long that immunity lasts is still a question. 486 00:24:31,071 --> 00:24:34,093 MARLON: The one thing I would want to say to parents is just ... 487 00:24:36,056 --> 00:24:39,034 is just watch your kids ... 488 00:24:39,040 --> 00:24:40,076 just be ... 489 00:24:45,000 --> 00:24:47,038 just be concerned. 490 00:24:47,038 --> 00:24:50,070 Because at first we thought we were being over protective. 491 00:24:51,062 --> 00:24:57,035 But I'm glad we were just a little bit over-concerned. 492 00:24:57,035 --> 00:25:00,091 FARYON: Since KPBS and the Watchdog Institute began its 493 00:25:00,091 --> 00:25:04,053 investigation, state health officials, the CDC 494 00:25:04,053 --> 00:25:08,016 and scientists from UCLA, including Dr. James Cherry, 495 00:25:08,016 --> 00:25:11,058 began a new study to determine whether the new strain 496 00:25:11,058 --> 00:25:13,045 of pertussis is contributing 497 00:25:13,045 --> 00:25:15,099 to the current whooping cough outbreak. 498 00:25:15,099 --> 00:25:18,060 For more on this story, and to see more of the data collected 499 00:25:18,060 --> 00:25:24,036 in our investigation, go to kpbs.org/whoopingcough 500 00:25:24,036 --> 00:25:27,075 and watchdoginstitute.org. 501 00:25:27,075 --> 00:25:30,021 For KPBS, the Watchdog Institute 502 00:25:30,021 --> 00:25:33,041 and Radio Netherlands Worldwide, I'm Joanne Faryon. 503 00:25:33,041 --> 00:25:35,091 Thanks for watching.