Vaccination~ by Suzanne Humphries M.D.

Vaccination~ by Suzanne Humphries M.D.

Most of the medical profession claims the issues surrounding vaccination have been “settled long ago, and laid to rest.” After my experiences in the hospital system and thoroughly examining both sides of the vaccination debate, it is clear that that isn’t the case.

Appearing in Issue #42. Order A Copy Today

The history of vaccination is more complicated than most people understand. The anti-vaccine movement is hundreds of years old. It heated up in the 1800s, when parents in the U.K. became fed up with watching their healthy infants and children become ill or die shortly after getting smallpox vaccinations, or later get sick from smallpox anyway. Parents and doctors who refused smallpox vaccines risked losing their homes, furniture and livelihoods if judges ruled against them.

The smallpox vaccines were made from pus scraped off of diseased cows’ belly sores, contaminated with disease matter from a variety of animals (and in some cases, humans). The smallpox vaccine history is not what you think it is, if you think vaccines wiped out smallpox.

Doctors and those administering vaccines are supposed to obtain “informed consent” before vaccinating. Informed consent is not possible, because parents are not given all the information they require to understand the most important issues.

I do not consider it my place to tell anyone whether to vaccinate or not. It is my place to understand as much as I can about vaccines and give people a more complete understanding from which to make their choices. This has never been a priority to the public health services. In fact there is ample documentation that the priority was quite the opposite, and actually to quell “any possible doubts, whether well founded or not” regarding vaccines. That priority has placed many lives in jeopardy, as major problems with vaccination were and are overlooked by vaccine policy makers.

There are many problems with the science that underpins vaccine information. I’ve yet to meet a pediatrician who is informed enough to offer informed consent. Infant immunity has been misunderstood by immunologists, as the immunology literature admits to. Only recently have some important questions been answered about why infant immune systems don’t function like adult ones. There is good reason for the tolerance that an infant has, and the answer is not to interrupt the program with aluminum and vaccines to ramp it up. Doing so is now known to have long-term consequences.

There is a paucity of studies comparing nevervaccinated children with partially or fully vaccinated children. In terms of safety studies, a major issue is that most vaccine studies use another vaccine as the control placebo, or use the background substance of the vaccine. There is a recent study, published in 2012 by Benjamin J. Cowling in Clinical Infectious Diseases, where a true saline placebo was used. That study showed no difference in influenza viral infection between groups, but, astonishingly, it revealed a 5–6 times higher rate of non-influenza viral infections in the vaccinated. It is no small wonder more true placebos are not used in vaccine research.

In the 2012 article “Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial,” published in the Canadian Medical Association Journal (CMAJ), we see a clear example of how false placebos are regularly used. Needless to say, giving untested vaccines which can be unknowingly contaminated, and with unproven effectiveness, is a “medical experiment,” and in my opinion, violates the core principles of the Nuremberg Code (informed and unambiguous consent). Most vaccines have never undergone carcinogenicity testing, for example, and likewise are rarely studied in pregnant women, which results in people taking vaccines, either by a proclaimed “emergency”; by a “public health” order from the WHO; by threat of imprisonment or loss of rights over one’s children; or by threat of being abandoned by the medical professionals providing care.

“Informed consent” is devoid of all meaning when people are tricked into taking vaccines by the use of misleading or frightening “information.”

Parents must learn the ways to take care of their children when they get the common childhood illnesses, whether they vaccinate or not, since vaccinated children can still get the diseases they were vaccinated against. In the case of unvaccinated children, who experience childhood maladies, effective home nursing most often allows children to recover naturally, and in most cases, the child will have long-term immunity.

Some vaccine policies have robbed teenagers and adults of the opportunity to get re-exposed and continue with natural immunity. For example, in mothers who were vaccinated against measles, placental transfer of antibodies is limited to a few months instead of more than a year in naturally immune mothers. Sometimes, mothers’ breast milk is devoid of the necessary antibodies they need to protect their newborns—especially if those mothers were vaccinated in childhood.

The above exemplifies but one of the many potential consequences we face as a result of vaccination for measles and other childhood illnesses, such as rubella.

Medical schools do not educate about the contents, dangers, effectiveness or necessity of vaccines. Most medical doctors are fearful of the natural childhood illnesses because they don’t have any idea how to safely assist patients through them. The limited mainstream treatment options I learned often caused the diseases to be worse than they had to be. Yet surprisingly, I discovered other methods which work extremely well, but were never presented as part of my medical education.

In a short article from Stanford Medicine, “Tapping the Immune System’s Secret,” the limitations of immunology are plainly spelled out. The public is repeatedly deceived in order to maintain participation in vaccination. All sorts of tactics are used. One of the most popular is to say that everyone should get vaccinated in order to protect the unvaccinated. This is commonly known as “herd immunity.” I have written an extensive article on herd immunity that can be accessed in the Pathways resource section.

Doctors repeat the advice, “We have to vaccinate them while they are young so the ‘take rate’ is high.” A case in point is an article for which I was interviewed in which one of Maine’s supposed top experts is giving misleading advice. In an article from Bangor Metro titled “A Shot to the Heart,” author Joy Hollowell also interviewed Dr. Jonathan Fanburg, president of the Maine Chapter of the American Academy of Pediatrics:

Concerns about how much a young child’s immune system can handle at one time have prompted some parents to stagger vaccinations. But Fanburg points out that there is no medical data to support the practice, adding that it’s actually more beneficial to vaccinate infants, rather than wait until they are older. “Children have a better ‘take’ of vaccines in their first two years of life,” he says. “There is a higher rate of immunogenicity, which is the child’s ability to produce antibodies to the vaccine antigen.”

Dr. Fanburg seems to lack understanding as to how an infant’s immune system develops and why. If he understood, he would pause for some time before making such a dogmatic statement.

A baby’s immune system produces only very small amounts of IL-1B and TNF-alpha. There was a time when experts thought that this was simply a defect in all newborn humans. In 2004, a study published by Lakshman Chelvarajan suggested that if vaccine manufacturers added various immune system kickers into vaccines, this would solve the problem and fix these perfectly normal children’s immune systems, which are so often described as being “defective” or “inadequate,” although they are completely age-appropriate, with characteristics shared by all land mammals.

Subunit vaccines like HepB, Strep Pneumo, Hib and Meningococcal have potent “adjuvants,” such as aluminum. Without them, the baby’s immune system sits there and does nothing. An adjuvant creates a red-alert situation, forcing the infant’s innate immune system to respond opposite to the way it should function in the first year of life. Pro-vaccine immunologists see nothing wrong with this.

By 2007, Chelvarajan was seeing things differently. In the last paragraph of a study published in the Journal of Leukocyte Biology, he wrote that whereas in the past, he had considered this a “defect,” he now considered it an important developmental program:

This anti-inflammatory phenotype may be beneficial to the neonate at a time when tissue growth and remodeling events are taking place at a rapid pace…thus the inability of the neonate to respond to infection with encapsulated bacteria may be the risk the organism takes for successful development.

In order to adjust to the world appropriately, an “anti-inflammatory phenotype” is critical to an infant. Breast milk acts as a stand-in innate immune system, which protects the baby from toxin-mediated and other diseases by supplying anti-inflammatory substances in the milk, along with other immune particles. These prevent bacteria and viruses from adhering, or kill them outright.

This protects the baby, acting as “in loco” defense while the infant immune system is being programmed to know self from non-self. This same pattern of development is seen in laboratories where they study non-human mammals, and is ubiquitous across mammals, showing that the anti-inflammatory phenotype is crucial to successful survival both short and long term.

A more recent article published in Nature by S. Elahi in 2013 shows that infant immune cells have full functional capacity, but are clamped down by design, while the infant immune system is learning to distinguish between “self,” healthy commensal microorganisms, and what should later be attacked by the activated and trained immune system.

During this period of “clamping,” which according to Dr. Elahi, is approximately two human years, the infant is well compensated by the mother’s human milk, which continues the educational process and kills unwanted organisms. What then, is the effect of vaccines, which interfere with the quiescent state of the infant immune system’s master plan, adding large amounts of aluminum?

With breast-milk support, an infant immune system develops appropriately and systematically— in its own due time, according to the genetic program placed in the baby at conception. What is that master plan? To enable the infant to safely transition into immunological independence with the minimum level of inflammation possible. Can that system be derailed? Yes it can. What can derail it? Anything which triggers an inflammatory response in the mother while she is pregnant, and in the baby by the use of a vaccination.

Ironically the medical research is very clear about one thing. It’s not the “infection,” per se, that causes problems. It’s the activation of the immune system. How do they know it’s not just the infection? Because stress, toxins and other non-infectious antigens can trigger the immune system cascade in very similar ways to infection.

If it is important for successful development of a baby to allow the risk of infection by not allowing two key parts of the primary infection defense to “fire,” what’s the other risk you might take, if you force an immune system to do something it’s not supposed to do? A vaccine, by definition, causes repeated, chronic inflammation at set time intervals. Vaccines are designed to create peripheral inflammation, and vaccine adjuvants and antigens can cause brain inflammation, and create allergies and autoimmunity—resulting in constant inflammation all around the body. For some children vaccines can also cause mitochondria to stop working properly.

You might now be thinking: If a baby’s default position is to not respond to toxin-mediated bacterial diseases, what chance does a baby have to survive in this world? If you would like to learn more about neonatal immunity, I invite you to read a three-part article accessible in the Pathways resource section, and take note of the medical articles referenced.

Pro-vaccine doctors sometimes cite “peer-reviewed literature” to supposedly prove their point, yet a closer look at their own literature often proves otherwise—as does a closer look at the sick population of vaccinated children they supposedly care for. Furthermore, a close look at medical textbooks through the decades reveals a very interesting trend. In the 1920s and ’30s, doctors were often quite relaxed over diseases which today are presented as more deadly than the plague. Many grandparents today are completely bemused at the way the medical profession describes infections which were, to most of them, straightforward holidays off school.

This is not stating that there were never serious consequences. There sometimes were. However, today, most parents erroneously believe that every child will die from diseases which most grandparents found were nuisance value only.

The medical system now considers measles more dangerous than the plague, and the most dangerous disease known to man. Yet there is no need to be afraid of measles, because well-nourished children who get adequate vitamin A have an unremarkable course to recovery. Boredom might be their biggest whine.

I have discovered that whooping cough isn’t something to be scared of either. In the days when my only tool was an antibiotic, whooping cough occasionally caused me considerable concern, but not today. I’ve watched many parents all over the world treat whooping cough simply by using high doses of vitamin C and occasionally homeopathy. They see rapid improvement and no serious complications. But you will not read about these cases in peer-reviewed literature and your doctor doesn’t know about them, because sick children—the ones they see and often create—are the only ones counted in the morbidity statistics. Healthy children who uneventfully recover are not seen by the medical system, and therefore are not counted.

The serious consequences from most childhood diseases come from just a few things: infant formula, cow’s milk, common medical drugs (especially antibiotics), malnutrition, vaccines and a lack of knowledge about simple methods of home nursing.

All of these barriers to recovery are completely avoidable in the United States and many other countries, and that is why we see so many healthy children who were never vaccinated, when we take the time to look.

In the accompanying chart, you can see how mortality for the common illnesses declined significantly long before the vaccines were created.

There a few common misconceptions about not vaccinating:

1. You are putting other people at risk by not vaccinating.

At risk for what? Chicken pox? Ask your grandmother if she knew anyone who died from measles. Different diseases have different degrees of severity in different age groups. The misconception that “if you don’t vaccinate, you place others at risk” is based on an assumption that vaccinated people do not get the disease they were vaccinated for. Did you know that a controlled study published in BMJ in 2006 showed that of all the whooping cough that was diagnosed, over 86 percent of the children were fully vaccinated and up-to-date for the whooping cough vaccine? There are similar studies showing that mumps and measles outbreaks often affect the vaccinated. People who are vaccinated can have their immune systems altered in a manner that leads to susceptibility to other infectious diseases, and can also leave them vulnerable to the disease they were vaccinated for, due to a phenomenon called “original antigenic sin.” Original antigenic sin is where an injected vaccine antigen programs the body to react in a manner that is incomplete, and different to the natural response to infection. When the vaccinated contact that disease again, they are unable to mount an effective response to the pathogen because vital first steps are missing. The whooping cough vaccine is an example of this.

A noteworthy study was published by Jason Warfel in 2013, looking at baboons, which are susceptible and manifest whooping cough like humans do. In the Warfel study, baboons who were either vaccinated or not vaccinated were later exposed to pertussis (whooping cough) bacteria, something that cannot be done experimentally in humans (due to ethical considerations), but which yields very important data. Expectedly, the baboons that had never been infected got the cough and remained colonized with bacteria for a maximum of 38 days. Baboons that were previously vaccinated and immune vaccine-style, became colonized upon later exposure for a longer time than the naïve baboons: 42 days. However, unvaccinated baboons that recovered naturally and were later exposed to the bacteria did not become colonized at all—zero days.

So, who is providing better herd immunity in the face of bacterial exposure? Vaccinated individuals who presume they are immune, yet remain asymptomatically colonized for 42 days, spreading bacteria? Unvaccinated kids who get infected and remain colonized for 38 days? Or the naturally convalesced who are not able to be colonized and therefore do not spread bacteria at all upon re-exposure? Better still: Natural convalescence makes for decades-longer, more solid immunity than vaccination.

Many vaccine enthusiasts like to invoke the term “herd immunity” to make the argument that the non-vaccinated pose a risk to the vaccinated. But the concept of herd immunity has no relevance to the vaccinated, as it was coined in reference to natural immunity in populations and what level the least epidemics occurred. There is no evidence whatsoever that having an 85 percent or 95 percent vaccination rate protects from outbreaks. This theory has been disproved time and again in highly vaccinated populations.

2. The non-vaccinated spread disease.

Actually it is the opposite. Live vaccines are known to spread to close contacts. One example published in 2011 in Science Direct addresses this, concluding that in a mumps outbreak in the Netherlands, “the risk of a close contact becoming infected by vaccinated patients was small, but present.”

We also know that in pertussis those who are vaccinated are more likely, due to original antigenic sin, to be carriers of the bacteria longer than the nonvaccinated, even when asymptomatic. In his article published in Clinical Infectious Disease in 2004, author James Cherry pointed out that adults, re-vaccinated against pertussis, don’t develop any antibacterial activity whatsoever. He went on to explain why: The current vaccines contain a few antigens, which create original antigenic sin, whereby the immune response to the vaccine is abnormal. That first-learned response then becomes the default position the immune system takes, on future booster shots. So in the case of the whooping cough vaccines, there are key protein virulence factors which have not been included in the vaccines, including ACT, TCF, TCT, BrkA and DNT.

Because the first three are not included, the default immune response does not prevent colonization. Furthermore, Cherry stated that the original antigenic sin results in the vaccinated being unable to clear the bacteria from their lungs. The non-vaccinated have immunity to all the front-line virulence factors, and very quickly clear the bacteria on re-exposure.

Mothers who have been vaccinated may develop surrogate markers which can be measured in a laboratory, but these do not guarantee efficient immune responses after exposure to the natural disease, because their first “learned response” was incorrect. Furthermore, they are still not sure what the surrogate marker actually is for pertussis.

There is similar information on measles, the other disease that has been portrayed by the media as a danger to the population due to non-vaccinated children. But this information is not accurate, nor is measles a dangerous disease in people who have sufficient vitamin A. Another author, B. Damien, pointed out in the September 1998 issue of the Journal of Medical Virology that the vaccinated are 5 to 8 times more susceptible to asymptomatic infection than the non-vaccinated. How then, are the non-vaccinated solely responsible for the recent outbreaks in measles?

Many vaccines are said to be “attenuated,” or modified-live, and supposedly do not infect, but over the decades we have seen how those attenuated viruses mutate once they are in a human and can spread more virulent disease than what is being vaccinated for. The oral polio vaccines in Nigeria today are a case in point. But this can happen with any attenuated viral vaccine.

The original Salk polio vaccines were supposed to be killed vaccines, and yet they infected thousands of people, killing and paralyzing more than 200 of them. This figure is thought to be a gross underestimate of the damage done.

It is not uncommon to see a child recently vaccinated for chicken pox develop shingles or chicken pox. I’ve also seen the shingles vaccine (which has 14 times the amount of virus as the chicken pox vaccine) provoke shingles in an elderly woman days after the vaccine was given. Strangely enough, it sent all of her doctors to start reading to see if shingles vaccines can cause shingles, because medical doctors know almost nothing about vaccines.

Here are things to consider when you hear of an outbreak of an infectious disease: How many of the affected were fully vaccinated, and how many people died or were put in the hospital? Were the cases verified with laboratory tests, or are the reports based on community doctor reports?

Another question to bear in mind is, Were the people hospitalized because the disease was really serious, or because the family didn’t know how to deal with it and responded to a medical profession hard-wired to believe everyone with that disease can die? In other words, was the admission to the hospital really necessary?

3. Deaths from these terrible diseases that once plagued humanity will return to pre-vaccine levels if we do not keep up the vaccines.

We can see from the graph on the opposite page that the mortality of these diseases was drastically declining prior to vaccination. In addition, you might want to know the more rational explanation for deadly disease decline in modern times. It’s not vaccination; it’s hygiene. In a 2002 article published in The Lancet, “What is the evidence for a causal link between hygiene and infections?” authors Allison E. Aiello and Elaine L. Larson offer the epidemiological evidence between hygiene practices and infections.

Here is something else you may not have been informed of by your healthcare professional: All the reduction, even for tuberculosis, was achieved before vaccines of any sort were offered in the U.S., and most of the reductions for all diseases were achieved before antibiotics became commercially available in about 1950 as well. So what did that? It wasn’t vaccines. Yet all the countries which used the BCG as front-line protection saw an identical decline to the one which we saw in the U.S. using no TB vaccine.

If you compare graphs for death declines in diphtheria and scarlet fever, they are almost identical. Yet there never was a widely used vaccine for scarlet fever. Scarlet fever—and its resulting complication, rheumatic fever—has clearly been shown in the medical literature to be nutritionally driven. This is why people who have had scarlet fever are primarily in war-torn, hungry and impoverished countries. In developed countries where rheumatic fever is an issue, it’s primarily seen among less-educated groups, whose nutritional understanding or access to good food is limited.

Yet undereducated people in stable social environments, without much money, who understand and follow effective nutritional pathways, will be on the scale of low susceptibility. It really is the nutrition and well-being that counts. It just so happens that low education, homelessness and poverty often coexist.

The reason rheumatic fever is a significant problem among poorer, less-educated, less-nourished groups is because poor nutrition is historically correlated with higher rates of rheumatic fever. All of us carry strep A regularly, but the well-fed amongst us don’t get scarlet fever, let alone its complication, rheumatic fever.

This point is documented enough to lay aside any concern over whether or not correlation implies causation.

Historically, in the case of infectious diseases, good nutrition has been and still is a major preventive factor. That has led to enormous declines of morbidity and mortality from most infectious diseases.

It’s not my place to tell anyone whether to vaccinate or not. But if people are going to choose wisely, they need to know the full ramifications of their options.

via PathwaystoFamilyWellness.org

Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel

Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel

Pertussis1

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Isaac Srugo*Comments to Author , Daniel Benilevi*, Ralph Madeb*, Sara Shapiro†, Tamy Shohat‡, Eli Somekh§, Yossi Rimmar*, Vladimir Gershtein†, Rosa Gershtein*, Esther Marva¶, and Nitza Lahat†
Author affiliations: *Department of Clinical Microbiology, Bnai Zion Medical Center, Haifa, Israel; †Serology Laboratory, Carmel Medical Center, Haifa, Israel; ‡Israel Center for Disease Control, Tel Aviv, Israel; §Wolfson Medical Center, Tel Aviv, Israel; ¶Public Health Laboratories, Jerusalem, Israel

Suggested citation for this article

Abstract

We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization’s case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.

Pertussis, an acute disease of the upper respiratory tract caused by the gram-negative bacillus Bordetella pertussis, lasts 6 to 8 weeks and has three clinical stages. The initial (catarrhal) stage resembles a common cold with a mild cough. The second (paroxysmal) stage is characterized by episodes of repetitive coughing during a single expiration, followed by a sudden inspiration that generates the typical “whoop.” The final (convalescent) stage, which lasts 1 to 2 weeks, marks a decrease in the severity and frequency of the cough.

Since the introduction of routine childhood vaccine, pertussis has been considered preventable, and pertussis-associated illness and deaths are uncommon (2). However, vaccine-induced immunity wanes after 5 to 10 years, making the vaccinated host vulnerable to infection (3). This susceptibility has been described in outbreaks of pertussis infection in highly vaccinated populations (36).

A recent study by Yaari et al. showed that infection in a vaccinated person causes milder, nonspecific disease, without the three classical clinical stages(7). Whooping cough is seen in only 6% of such cases; instead, the illness is characterized by a nonspecific, prolonged cough, lasting several weeks to months. Because of these atypical symptoms, pertussis infection is underdiagnosed in adults and adolescents, who may be reservoirs for infection of unvaccinated infants (810). In a study in France, up to 80% of infections in unvaccinated children were acquired from siblings and parents, suggesting that adults and even young siblings play a fundamental role in the transmission of pertussis (11).

We demonstrated B. pertussis infection in fully vaccinated children ages 2-3 years and 5-6 years who had contact with an infected child. We investigated whether younger or recently vaccinated children may be protected from classical clinical illness but remain susceptible to infection and become asymptomatic carriers.

The Study

We examined the family of a 4-month-old infant who died of pertussis in Israel, as well as children at two day-care centers that two siblings had attended during the infant’s illness. The two siblings, ages 2 and 5 years, attended different day-care centers, for ages 2-3 years and 5-6 years, respectively. Both siblings continued to attend the centers despite paroxysmal cough for 4 to 5 weeks. Thirty other children attended the day-care center for the 2- to 3-year-old group. Sixteen other children attended the center for the 5- to 6-year-old group.

Thumbnail of Timeline of pertussis infection in children in two day-care centers, IsraelFigure. Timeline of pertussis infection in children in two day-care centers, Israel

In the infant’s family, a third sibling, age 11 years, also had a paroxysmal cough of 4 to 5 weeks duration. The 35-year-old mother had a 3-month history of persistent cough. An 18-year-old aunt, who took care of the infant and lived in the same house, reported a mild respiratory illness without paroxysmal cough. None of the family members had a whooping episode, cyanosis, or pneumonia (Figure).

All the children in the day-care centers had been immunized in infancy with all four doses of Pasteur diphtheria-tetanus toxoid pertussis (DTP) vaccine, which includes a booster dose at 12 months of age. The Pasteur vaccine contains 1 immunization dose (ID) of purified diphtheria toxoid, 1 ID of purified tetanus toxoid, and >4 IU of B. pertussis. All family members of the infant were also fully vaccinated with four doses of DTP. The infant had received only the first dose of vaccine at 2 months of age.

The five family members of the infant and the 46 children in the two day-care centers were tested for B. pertussis. Two nasopharyngeal specimens were taken with Dacron swabs (Medical Wire, MEDECO, Corsham, UK); one specimen was used for culture and the other for polymerase chain reaction (PCR) testing. The culture specimen was immediately spread on charcoal agar plates (Hy Labs, Rehovot, Israel), which were incubated at 37°C for 14 days. Serum samples were also taken from every study participant for specific testing for immunoglobulin (Ig) M, IgA, and IgG antibodies to B. pertussis by an enzyme immunoassay (EIA) with whole-cell antigens (Panbio, East Brisbane, Australia) (12). Primers for the repeated insertion sequences were used in a semi-nested PCR assay (1314). The upstream primer sequence gATTCAATAggTTgTATgCATggTT and downstream primer AATTgCTggACCAT TCgAgTCgACG were used in the first PCR, which included 5 µL sample DNA, reaction buffer (10 mM Tris-HCl, 50 mM KCl, 1.5 mM MgCl2, 0.1% Triton X-100), 1 µM of each primer, 200 µM deoxynucleotide triphosphate, and 1 U Taq polymerase (Boehringer Mannheim, Germany) in a 25-µL volume (14). Statistical analysis was performed by the two-tailed Fischer’s exact test.

A person with positive PCR results was considered to have B. pertussis colonization of the nasopharynx. A person with positive IgM serum antibodies was considered to have had a recent infection. There were no culture-positive results, and nasopharyngeal aspirates were not available from the infant. Positivity by PCR or IgM did not indicate presence of symptoms.

Information on clinical symptoms was obtained from each person by a detailed questionnaire. The children in the day-care centers were followed clinically for 8 weeks after laboratory testing. All family members had been treated with erythromycin before testing, but no antibiotics were administered to the children in the day-care centers.

Eleven percent of the children in the two day-care centers were PCR positive, indicating nasopharyngeal colonization: 4 (25%) of the 16 5- to 6-year-old and 1 (3%) of the 30 2- to 3-year-old children (p <.05). Nine (55%) 5- to 6-year-old children were positive for serum IgM antibodies, and 4 (25%) were IgA positive. Three (10%) of the 2- to 3-year-old children were IgM positive, and 1 (3%) had IgA antibodies. Nasopharyngeal colonization was found more frequently in the 5- to 6-year-old than in the 2- to 3-year-old children (4/16 vs. 1/30, p <.05). This trend was also constant with IgM and IgA serum antibodies (9/16 vs. 3/30, p <.001 and 4/16 vs. 0/30, p <.01, respectively). In the index family, four of five members were positive by PCR, including all three siblings of the infant and the 18-year-old aunt. The 35-year-old mother, who was treated with erythromycin before testing, was negative by PCR. All five family members, including the mother, had high levels of IgM antibodies, indicating recent infection. The 4-month-old infant was seronegative for all subclasses of Ig antibodies to B. pertussis. No cultures were grown from the three groups.

According to a modified World Health Organization (WHO) case definition, two (11%) of the five children colonized with B. pertussis in the two day-care centers had the typical course of pertussis infection, with 3 weeks of paroxysmal cough (Table) (1). The other three children who were positive by PCR had only a mild, nonspecific cough during follow-up.

Conclusions

The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (37). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (311). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (1517). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.

We used PCR, EIA, and culture to confirm B. pertussis infection in two highly vaccinated groups of children in two day-care centers. Three (10%) of 30 2- to 3-year-old children were seropositive for recent infection; one had nasopharyngeal colonization and a clinical illness that met the modified WHO case definition. In the day-care center for the 5- to 6-year-old group, 9 (55%) of 16 children were IgM positive, 4 (25%) of whom had nasopharyngeal colonization. Of these four children, three had nonspecific cough, and only one met the modified WHO definition for pertussis. None of the children in our study, including those who met the WHO definition, had been examined by a physician before our investigation.

Children who were seropositive and remained both asymptomatic and PCR negative probably had sufficient immunity from vaccines or natural boosters to protect them against persistent colonization and clinical disease. Their seropositivity could not be due to vaccine because the children were tested more than a year after having been vaccinated. Yet not all the children were protected from infection and from colonization with the bacteria. Whether a child who is serologically or PCR positive for pertussis and is clinically asymptomatic is a potential transmitter of infection has not been established. What is certain, however, is that vaccine-induced immunity against infection does not persist throughout adulthood. In France, booster vaccinations have been recommended for adolescents and teenagers (18). We found that immunity does not even persist into early childhood in some cases. We also observed that DPT vaccine does not fully protect children against the level of clinical disease defined by WHO. Our results indicate that children ages 5-6 years and possibly younger, ages 2-3 years, play a role as silent reservoirs in the transmission of pertussis in the community. More studies are needed to find the immunologic basis of protection against infection and colonization and thus an effective way to eradicate pertussis.

Dr. Srugo is a senior lecturer and director of the Clinical Microbiology and Pediatric Infectious Disease unit at the Bnai Zion Medical Center, Haifa, Israel.

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Suggested citation: Srugo I, Benilevi D, Madeb R, Shaprio S, Shohat T, Somekh E, et al. Pertussis Infection in Fully Vaccinated Children in Day-Care Centers, Israel. Emerg Infect Dis [serial on the Internet]. 2000, Oct [date cited]. Available from http://wwwnc.cdc.gov/eid/article/6/5/00-0512

DOI: 10.3201/eid0605.000512

Table of Contents – Volume 6, Number 5—October 2000

Article copied from CDC.GOV