California is in the midst of its worst whooping cough outbreak in 50 years. Before a vaccine was available, whooping cough killed around 5000 Americans a year, mostly infants. Add to that the substantial morbidity it caused and whooping cough was a major public health issue. When the whooping cough vaccine became available in the 1940’s, the number of cases declined precipitously. Since the 1980’s, however, the number of whooping cough cases has been on the rise.
Whooping cough is not a trivial disease. It is caused by a bacteria called Bordetella pertussis that infects the lungs. Apart from the small mortality risk, the two things that make whooping cough so bad are the intensity of the disease and the duration. The “whoop” in whooping cough refers to the characteristic noise made when its sufferers cough. It has also been referred to as a bark, honk, or seal-like noise. The cough is so severe that it is not uncommon for sufferers to cough until they vomit or crack ribs. Whooping cough is also known as the “100-day cough”. After the acute illness subsides, the cough can linger for months.
Back to California. A recent NY Times article illustrates some of the reasons for the return of this old foe. It highlights Marin County, a wealthy bay area enclave that is home to 0.5% of the states’ population, but 15% of the states’ whooping cough cases. In Marin county, 13% of infants and children remain unvaccinated, the 7th highest rate in the state. It is this lack of vaccination that allows diseases like whooping cough to gain a foothold in a community.
I’ve said it before in this blog, but it bears repeating: vaccines may be the most important public health advance in the history of mankind and that is not hyperbole. In order for them to be maximally effective, to achieve herd immunity, they need to be used universally. Some vaccines are better than others, but they are all better than nothing. The risks of vaccination are negligible, especially when compared with the risk of not vaccinating.
Finally, when considering not vaccinating your child, remember that you are not only putting your child at risk, but you are also increasing the risk for every other individual in the community.