Whooping cough vaccine while pregnant, worrying?

[Keznel]

Just wondering if anyone else feeling reluctant to get the whooping cough vaccination now recommended for 28-38wks pregnant? I'm currently 20wks and really concerned about getting it, but guess I have plenty of time to make my mind up yet . I had DD in the peak of a whooping cough epidemic back (last year) when it wasn't offered to pregnant women! She thankfully was fine and got her own vaccinations at 8wks etc Just wondering if I'm alone in stressing about this? Or should I just do as I'm told and get it?

In 1945 there were a similar number of cases and hundreds of deaths, so 'natural boosters' didn't seem much use then.

In 1945 there was no NHS. Look how the deaths started to fall after 1948...

I'm not saying its any one thing. Just wondering why there is a higher proportion of deaths all of a sudden.

Age breakdown from 2008-2012 here
www.hpa.org.uk/NewsCentre/NationalPressReleases/2013PressReleases/130201Casesofwhoopingcoughdeclineafterrecordnumbers/

The biggest increase in cases has been in the over 15s. From the table there, there was a 9x increase in cases, and only a doubling of cases in newborns, however if there were 7 deaths in 2011 and 14 in 2012 that's about right, as it seems it is generally newborns that die from it.

I was hoping to have a breakdown of figures from a longer time ago to compare. Not much has changed with the vaccine from 2008-2012.

Is your google broken?

Patronising again NG?

Yes, this time. Bored of you asking stuff then dismissing the answers as not what you wanted. Google it yourself and report back your findings about 'natural boosters', hmm?

NG, I'm not sure why you're being dismissive of the idea of natural boosters - it's the same as getting a 'booster' vaccine only it comes from coming into contact with the disease naturally. If the disease isn't circulating as widely in the community then this is less likely to happen. I was merely wondering if that is perhaps why women's immunity levels to WC aren't high enough to pass on protective levels of antibodies to their newborn. Although with the increase in WC cases it is more likely that we'll come into contact with it.

"You haven't provided anything yourself to counter them."
I've demolished it by the simple application of primary maths (which I did get wrong in vaccines favour at first!) Do you stand by it?

You misunderstand by the way. I wasn't referring to the placebo effect in vaccines, just how faith generally is an important part of placebo treatment (you and everyone knows this I think) and can play a role in pharmaceutical treatment too, as you say.

The thing about sensation media reporting leading to more people thinking they're poorly, that does apply perfectly to Swansea by the way. A media frenzy, followed by hundreds of "cases" that weren't anything of the sort.

But you didn't say. Do you really think people only report vaccine damage because they read about it in the paper? What about the people who reported it before anything made the papers? What about the parents expressing fears of autism and auto immune problem MMR links before anybody even heard of Andrew Wakefield, for example?

On whooping cough, nobody seems worried that this vaccine might not even protect against parapertussis, which is apparently a mutated strain also spreading. What's the breakdown of figures on that? They don't publish that do they.

I've just done some googling, found this on Medscape, not something I've looked at before, I suppose I'll have to check its credentials. Maybe it's why the death rate has gone up, maybe the worst cases are the parapertussis strain which the vaccinedoesn't protectagain.

B parapertussis has been reported to cause whooping cough either as a single infective agent or with coinfection with B pertussis in almost 40% of laboratory-confirmed cases.[1]

Parapertussis afflicts very young infants as well as adults. The clinical presentation of B parapertussis infection is variable: 40% of infected persons may be asymptomatic, but most patients have paroxysmal cough that lasts for less than a week, with the entire illness lasting for less than 3 to 4 weeks.[4] Whoop has been reported in almost 60% of patients with parapertussis, but usually its persistence is of shorter duration than that seen in patients with pertussis. Post-tussive emesis as well as nocturnal cough are less frequent in those with parapertussis than in those with pertussis.[5]

Lymphocytosis observed in patients with pertussis is caused by PT, and because B parapertussis does not produce PT, lymphocytosis is not observed in patients with parapertussis.[6]Severe cases of whooping cough are associated with dual infection with B pertussis and B parapertussis.[7] Parapertussis confers long-lasting immunity, but there is no cross-immunity between pertussis and parapertussis.[8,9] Therefore, vaccination against pertussis does not protect against parapertussis.[10]

The diagnosis of parapertussis can be made in a number of ways. B parapertussis is less fastidious than B pertussis and can be grown from nasopharyngeal secretions in 2 to 3 days on the same culture medium (Bordet-Gengou agar) used to isolate B pertussis. The direct fluorescent an tibody test performed on nasopharyngeal specimens provides rapid diagnosis, but the test has low sensitivity and specificity and therefore needs to be performed simultaneously with culture.[11] Recently, PCR assays performed on nasopharyngeal specimens have been shown to provide rapid diagnosis with high specificity and sensitivity.[3]

To date, no studies have been conducted on the management of parapertussis. Because many persons infected with B parapertussis are asymptomatic and the majority have a mild course, many infections remain undetected. These persons can act as carriers of infection, however, and may transmit the disease to young infants, who may have a severe course. In fact, fatality from parapertussis has been reported.[7] Thus, it may be important to treat all patients who have B parapertussis infections.

In vitro studies have shown that in general, B parapertussis is more resistant to antibiotics than B pertussis, and the minimal inhibitory concentration (MIC) of most antibiotics is higher for B parapertussis than for B pertussis, except for TMP-SMX and fluoroquinolones. Erythromycin may not be effective in eradicating B parapertussis, because the peak concentration it achieves in respiratory secretions is only 2-fold higher than the MIC90 for B parapertussis. In addition, the concentration of erythromycin in bronchial secretions may vary considerably.[13,14] Because the MICs for TMP-SMX and fluoroquinolones are low and also because the newer fluoroquinolones achieve higher concentrations in respiratory secretions, these drugs may be more effective in eradicating B parapertussis. The role of macrolides (azithromycin and clarithromycin) in the management of parapertussis is not clear.

Because there have been no treatment studies, it is not surprising that there are no data available on the prophylaxis of B parapertussis infection. In the case of our day-care center, we do not know whether prophylactic agents administered to day-care attendees and their parents prevented further spread of parapertussis, because the majority of the day-care attendees were infants and maternal antibodies could have protected at least some of them.

noble Do you not believe in the concept of natural boosters against WC? Wouldn't we just all be coming down with it every ten to 15 years or so, given that most of us haven't had a jab against it for some years? In my case, that's some decades.

www.cidd.psu.edu/research/synopses/acellular-vaccine-enhancement-b.-parapertussis
That's worth a read.

www.cidd.psu.edu/research/synopses/acellular-vaccine-enhancement-b.-parapertussis

Well, that's not very good. It says vaccination with acellular pertussis vaccine (is that what we give pregnant women) increased parapertussis in mice lungs by forty times.

A 40 fold increase would be a 4,000 per cent increase, isn't that right.

Snap snap snap.

Or to put it in context: a 40-fold increase in the less serious parapertussis and a 700-fold, that's seventy thousand, I repeat 70,000 percent, decrease in the more serious pertussis.

It's good to see Tabitha giving approving citations to research recommending extending vaccination programs.

Tabitha, no, you wouldn't be expected to come down with it every 15 years if widespread vaccination means that you don't come into contact with it! Like none of us get smallpox any more despite not being immune.

The massive increase in cases in this outbreak has been in the 15+ years age category, suggesting that people are coming down with it when immunity wears off rather than getting a 'natural booster'. It's not one of those things that you can only get once.

I had whooping cough as a child. I'd be interested to see if my immunity has waned. Didn't it used to be thought that you only get whooping cough once? Must have a look to see if there are figures showing the cases in adults years ago.

NG, you just said that there wouldn't be enough of it around for people to get a natural booster due to widespread vaccination.

Bumbley, natural immunity is only supposed to last 12-20 years so you're probably not immune any more. I think my MIL has had it twice.

What I meant was that it is now around, there's an outbreak, and older people who were immune (from vaccination or from having it) are getting it rather than having their immunity boosted.

Jo "It's good to see Tabitha giving approving citations to research recommending extending vaccination programs."
I am not quite sure why you said that mentioning me in particular.

Surely if I came into contact with WC say every five years, I would get a natural booster? I would catch the virus but my immune system would know how to deal with it. If Bumbley has come into contact with it a few times since having it as a child, might she not still be immune?

"40-fold increase in the less serious parapertussis "

Less serious in adults - so mild as to not present with symptoms - but can be severe in young infants and is less susceptible to anti-biotics. It's all in that copy and paste I did. You could read it if you like.

In vitro studies have shown that in general, B parapertussis is more resistant to antibiotics than B pertussis

The "40 fold" refers not to the increase in parapertussis (I couldn't find figures) but to the amount of vaccine aluminium which a baby's kidneys have to process compared to breastmilk aluminium (according to figures from noblegiraffe).

Don't you just hate when people ruin what is a useful and interesting thread in order to try to show that they know more than the rest?

Anyway, I saw Keznel's message and it reminded me of the thoughts I went through when I was pregnant with my DD last year. I had the same thoughts and dilemas about the untested vaccine, the aluminium levels and the fact that the immunity passed to the baby somewhat dampens the baby's immunity to their childhood vaccinations. I contacted the pharmaceutical company that makes the vaccine and made a freedom of information request to the MHRA for details of reported adverse events during preganancy and neonates. After much searching I came to the conclusion that there just isn't any information regarding safety one way or the other. I also found healthcare professionals were clueless and unable to share any useful information about this and they seemed to be blindly following the Department of Health guidelines). When I tired to discuss it with the nurse who was immunising pregnant women I received the response "If you don't want to have it you don't have to", which is clearly obvious and not at all helpful. In the end I opted to have the whooping cough vaccine but later on in pregnancy (week 35 so that I had enough time to make an immune response to pass protection to my baby). Now I have a 6 month old daughter and luckily she overall healthy for now. I also know another 10 pregnant friends who had the vaccine and so far all seems ok. But of course that is not to say that some effect may not arise later.

Regarding the aluminium, this is everywhere and very hard to avoid. I was horrified to learn that soya had lots of aluminium at the time when I was having soya milk to see if a lactose free diet would help my baby's colic. I have been avoiding anti-persiparant deodrants due to their aluminium content and yet I was drinking it by the bucket load! I try to minimise the aluminium my baby gets but unfortunately have had to accept that some if it just cannot be avoided and what is in vaccines seems to not be so much compared to other things that you come across in every day life.

These days it is almost impossible to avoid these "nasties" but we all try our best. I think that Keznel you sound like a very informed person who has widely read around the whooping cough vaccine. Nobody has the perfect answer for you simply because it is an unknown. Despite trying to talk to others for their opinions or for professional opinions, I did not find it helped at all. I found other mums just took the view that they had the vaccine because they thought that if thye NHS were advising it then it must be the best option (naively I think.....I think we can all think back to the famous thalidomide fiasco that arose from another unknown advocated by the NHS). I did not come across anybody I knew for whom it actually crossed their minds the potential effects to their babies (not because they weren't concerned about their babies, they simply just didn't think of it). I remember thinking that I wished I could be that naive too so that I did not feel the burden of the decision and potential guilt in case it turned out I made the wrong decision.
I truly think that this is a decision that you need to make yourself based on everyhting you know and your gut feeling. It is you that has to live with any consequences, be they good or be they bad.

I guess you must have made your decision by now, and I am sure it was the correct one for you and your baby.