Vaccination part 12

Pertussis

Pertussis (whooping cough) is a highly contagious disease of childhood (R0 15–17, comparable to measles) transmitted by respiratory aerosols, with the principal vectors of transmission being asymptomatic adult carriers of the bacterium Bordetella pertussis.

Pertussis was first reported in France in the 15th century, and Bordetella pertussis appears to have emerged from or in parallel to the agent of kennel cough (Bordetella bronchiseptica) in dogs.

Although pertussis mortality is dramatically reduced in economically privileged societies from 19th century figures, with the disease today typically modest in its appearance, the disease can be debilitating & terrifying, warranting efforts at prevention worthwhile.

Pertussis mortality in economically privileged societies decreased precipitously in the early 20th century well before introduction of the whole-cell pertussis vaccine in 1948,

likely due to improved living conditions in general, in parallel with a reduction in all-cause childhood mortality.

Following introduction of the whole-cell pertussis vaccine (the pertussis component of the DPT) in 1948, the incidence of reported pertussis cases declined dramatically.

It’s likely that one partial explanation for the extremely low rate of reporting of pertussis in the 1970s-1980s, was underreporting due to provider unfamiliarity with pertussis & failure to diagnose other than severe cases, under the assumption that pertussis had been “eliminated” by near-universal vaccination. In the 1940s-1950s we all had it as children, but physicians in the 1970s-1980s largely assumed it was “gone” and were not well positioned from their training to recognize garden-variety cases.

The association of the DPT vaccine with infantile seizures in the 1980s (attributed by the industry, and widely accepted within conventional medical circles to have been the coincidence of the onset of idiopathic epilepsy with the vaccination schedule) resulted in the National Childhood Vaccine Injury Act of 1986, and the replacement of the whole-cell pertussis vaccine with an acellular preparation targeting the pertussis exotoxin in the Dtap and Tdap vaccines in current use. These, unlike the whole-cell vaccine, do not induce sterilizing immunity & do not impact significantly on community transmission, resulting in a modest “rebound” of pertussis in recent years.

The current CDC vaccination schedule calls for an initial dose of the Dtap vaccine at 2 months, boosted at 4, 6, and 15 months:

Protection from birth - 2 months, a population in which the disease is most concerning, is dependent on maternally-conferred passive immunity. In the era prior to vaccination, women of childbearing age universally possessed “lifelong” immunity from childhood infection, “boosted” by periodic asymptomatic exposure to pertussis circulating in the community, which could be passively transferred to the infant via transplacental & breastmilk transfer; this maternal exposure has been disrupted by widespread use of the DPT vaccine, and presently the Tdap vaccine is recommended to pregnant women at 27 through 36 weeks gestation to provide for the transfer of passive immunity to the infant for this critical period.

“Cocooning” is also often recommended, involving vaccination of older children & adults who may be in contact with the infant. This latter has proven ineffective, both due to impracticality of the logistics involved, and due to the ineffectiveness of the current pertussis vaccines (Dtap and Tdap) in providing sterilizing immunity. It might seem that preventing symptomatic pertussis might reduce the risk of community transmission, but the reverse appears to be the case; pertussis is transmitted by respiratory aerosols independent of cough or catarrh, and asymptomatic or minimally symptomatic adults (perhaps presenting with “common cold” symptoms), including those with presumed immunity from vaccination, serve as the primary (“stealth”) vectors of community transmission.

The Dtap & Tdap vaccines do not appear to be associated with the encephalitis & infantile seizures seen with the whole-cell pertussis component of the DPT. Although concerns exist with some regarding a presumed association of vaccination in general with autism, these appear to be unfounded, and originated specifically with the MMR vaccine, never implicating the Dtap vaccine.

Homeopathic management of Pertussis includes the treatment of cases according to the Totality of characterizing signs & symptoms, with one of a large (over 160) collection of potential remedies requiring some experience both with pertussis and with homeopathic case management in general, and short-term homeoprophylaxis, typically using a genus epidemicus when one can be discerned in a local outbreak (see aphorisms 101-104 in the Organon), or a “genus” remedy of Pertussis, most commonly Drosera rotundifolia. Although sometimes oversimplified as a task suitable for the home prescriber according to simplified “homeotherapeutic” protocols, this is a task for an experienced prescriber and is not to be undertaken lightly.