Immunization: The Best Weapon Against the Resurgent Threat of Whooping Cough

17 Feb 2016

Many Americans, in the Jewish and other communities, are skeptical of medical scientific recommendations, particularly when they involve mandates. The reasons are complex but include a concern about profit motives creating bias, scientific fraud, a sense that “natural” interventions are better and a skepticism about science especially when it contradicts religious belief. While all these concerns are understandable, there are times when the medical evidence is strong and solid and it has been clearly shown without any doubt that certain treatments are life-saving, cost effective and beneficial. Vaccines are such a case.

Recently, California enacted a new state law that reduces exceptions to vaccination mandates for students, becoming the third state to exclude exemptions based on both religious and philosophical beliefs. A similar bill is under consideration in New York State, after an outbreak of whooping cough hit New York City’s Brooklyn neighborhoods especially hard, with more than 100 cases reported. Children and toddlers accounted for 90% of the cases, and half of these children were either unvaccinated or had not received all their recommended shots. Five babies had to be hospitalized, and one developed pneumonia. While the Centers for Disease Control (CDC) recommends that pregnant women be immunized against pertussis with booster shots, which helps protect vulnerable newborns from infection, just three of the 37 mothers whose children were affected by the outbreak had been immunized. Elementary, high school and college age students were affected as well and in turn, the school environment was compromised.

The United States saw its largest outbreak of whooping cough in almost 60 years, in 2012. This extremely contagious bacterial infection killed 20 people, and sickened nearly 50,000. Beyond the NYC outbreak, the complete numbers aren’t in yet for 2015, but the figures for 2013 and 2014 don’t look good. The CDC recorded about 29,000 cases of whooping cough in 2013, and the number of cases crept back up to nearly 33,000 in 2014.

Caused by a toxin-secreting bacterium known as Bordetella pertussis, whooping cough can cause coughing so severe that it may lead to vomiting, loss of consciousness, and even broken ribs. The infection spreads through coughs and sneezes. Day care facilities, elementary schools, high schools, and colleges and academic institutions are prime hotspots for contagion and the NYC outbreak has challenged schools and colleges throughout the area. That’s why all 50 US states have laws on the books that require students to have proof of immunization in order to attend school. Some specific population groups may be at increased risk for outbreaks. The Orthodox Jewish community, where children and teenagers spend extended periods of time in classrooms and study, and can report that this group has been affected in recent years by these and other outbreaks, as noted in a study on mumps transmission published in the New England Journal of Medicine.

 The DTP vaccine (which also protects children from diphtheria and tetanus), was introduced in the late 1940s. As immunization took hold, the incidence of pertussis in the US dropped sharply, from upwards of 150,000 cases per year to well below 10,000 annually by 1965.

Why has this deadly, vaccine-preventable disease become a threat again? The troubling trend of parents deciding to “opt out” of immunization requirements is a key factor. As recent history shows, families who make this choice aren’t only putting their own children at risk; they are also endangering others in the community. When immunization rates drop, it’s much easier for disease to spread.

In the Jewish community which was impacted by this fall’s whooping cough outbreak, the vast majority of cases were found in children who had not been vaccinated properly. The New York State Department of Health urged parents to vaccinate on time as it is the best way to protect their children from pertussis and other vaccine-preventable infections. Some in the community have resisted vaccination as a matter of personal belief in their safety, but many have simply not gotten around to doing it for one reason or another.

Much of the unfounded anxiety about the risks of vaccines can be traced to a 1998 study in The Lancet, a leading British medical journal, that linked the measles, mumps and rubella (MMR) vaccine to bowel disease and autism. The study’s author, Dr. Andrew Wakefield, hadn’t disclosed that lawyers for parents seeking to sue vaccine makers for damages had helped fund his research. He also didn’t mention that the previous year, he’d patented a measles vaccine that was poised to hit the market if the MMR shot was withdrawn. The Lancet wound up retracting the paper, and the British Medical Council banned Wakefield from practicing medicine in the UK.

Nevertheless, the spurious association between vaccines and autism lives on. And parents across the US continue to stretch out or even skip vaccines.

Immunization was one of the most important triumphs of 20th century medicine. One could argue that vaccines have been more crucial to improving the public health than any other breakthrough, from antibiotics to cancer cures. And vaccines don’t just prevent hundreds of thousands of cases of infectious disease each year. They’re also an excellent investment. In a 2014 study published in Pediatrics, CDC researchers calculated that among the roughly 4 million children born in 2009, routine childhood immunization will prevent about 42,000 early deaths and 20 million cases of disease. The researchers also pegged savings for full immunization at $13.5 billion in direct costs (such as medication and hospital care) and $68.8 billion in societal costs (for example, lost work time for parents caring for sick children). Every dollar spent on routine childhood immunization, the CDC calculates, saves $3 in direct costs and $10 in societal costs.

About half of babies who contract whooping cough are hospitalized, and four out of five of infants infected with the disease caught it from someone at home, so the CDC is also emphasizing the importance of immunization for pregnant women (who can pass some of their immunity on to their newborn), infants’ family members, and childcare providers.

Parents, physicians, schools and public health officials must work together to make sure the great gains we’ve achieved don’t erode in the 21st century. While the schedule of shots for young children can seem overwhelming to new parents, immunization is extremely safe, and sticking to the recommended schedule will ensure that children are fully and safely immunized and that they and their peers are protected as they progress through the school years. In the face of recent outbreaks in the Jewish community, our leaders must inform parents about the critical role vaccination plays in protecting against potentially threatening diseases and urge them not to be deterred by scientific reports that have since been retracted.  In the words of a Brooklyn pediatrician, Dr. Robert Adler, “Vaccination is a way of being makdim refuah l’makah [preempting sickness with a cure], which is a very Jewish concept.”

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.