Washington pertussis outbreak is very, very bad

By Phil Plait | July 24, 2012 9:42 am

This is one of the scariest graphs I’ve seen in a long time.

This plot, from the CDC, shows probable and confirmed cases of pertussis – whooping cough – in the state of Washington from 2011 through June 2012. Last year’s numbers are the short, light-blue-grey rectangles, and this year’s are the dark blue. The plot is by week, so you can see the 2011 numbers slowly growing across the year; then this year’s numbers suddenly taking a huge leap upward. They are reporting the new rate as 13 times larger than last year. Note that 83% of these cases have been confirmed as being pertussis, while 17% are probable. The drop in recent weeks is due to a lag in complete reporting of cases.

Got that? There are 13 times as many people – more than 2500 in total so far – getting pertussis right now as there were last year at this time in Washington.

Some of this increase may be attributable to the pertussis bacterium growing a resistance to the vaccine and booster. However, it’s curious that Washington state has seen such a large jump; the incidence of pertussis overall in that state is nine times higher than the national average.

Why would this be? Well, it so happens that the antivax movement is quite strong in Washington state, and it also so happens that parents are choosing not to vaccinate their children in higher numbers there than the rest of the nation.

There may be other factors, but it’s clear that people who don’t vaccinate are at least partially to blame for this. Maybe it’s due to religious reasons, or the large number of antivaxxers who still blame autism on vaccines, when we know for sure that’s not the case. Either way, when vaccine rates get too low, herd immunity is compromised, and we see more pertussis cases, even among those who are vaccinated.

Pertussis is a terrible, terrible disease. It puts infants at grave risk of dying, and eight infants so far this year have been killed by pertussis in the US. Even if it doesn’t kill them, it’s a horrible thing to put them through.

Vaccines save lives. Talk to your board-certified doctor and find out if you need one, or a booster. I did, and my whole family is up-to-date with their vaccinations. I refuse to be a part of spreading a disease that can kill anyone, let alone babies, and I refuse to be silent about it.

Tip o’ the needle to Steven Saltzberg at Genomics, Evolution, and Pseudoscience and mims on Twitter.


Related Posts:

Not vaccinated? No kisses!
Whooping cough outbreak in Boulder
Pertussis can kill, and you can help stop it
Pertussis and measles are coming back

Comments (86)

  1. RAF

    I have a brand new grand daughter living in Washington state…

    I hate to even say this, but when will the government step in and stop this insanity?

  2. It’s on the rise here in Minnesota too, although not as extreme as WA. One of my co-workers was just put in the “probable” category. Turns out I am the *only* person working here who has had the pertussis vaccine as an adult.

  3. Keith Bowden

    Vaccinated and proud to be rational.

    I think we need to start referring to “alt-med” as “fantasy med”; “alternative” sounds too reasonable whereas “fantasy” leaves no doubt as to the implied efficacy.

  4. A minor point (which hardly seems worth bringing up, given the seriousness of what you’re reporting), but I think you meant to write “the large number of antivaxxers who still blame autism on vaccines” (or “… who still blame vaccines for autism”). I’m not aware that anyone thinks autism causes vaccination.

  5. The recent outbreaks of pertussis around the country indicate to me two things: one, there’s a huge problem with people (esp. adults) not vaccinating and getting their boosters; two, we really need to work on a new pertussis vaccine that has better efficacy and/or longer duration of efficacy. These are probably the biggest things that need to be fixed if we want to curb the spread of this disease. I’m not sure if the first part can be fixed, and the latter will take years and years of research and development. In the meantime, more frequent boosters are probably the answer.

    Oh, and to those who are opposed to immunization, please click on my name and read that link before commenting. Also, if you plan to bring up the whole “more immunized get sick than unimmunized” trope, read this link. Steve’s article in Forbes is also well worth perusing.

  6. Really scaring how a handful of lies can vanificate years spent to try to save lifes …

  7. Luis Dias

    Antivaxxers are irrational idiots, but to blame this phenomena on them is equally irrational. The worst, however is that alledgedly, Phil has no excuse. He *is* a so-called skeptic. He should be aware of the sillyness of his rationale. His rationale is actually that the sudden jump in pertussis this year is caused by the slow trend of less vaccination. His evidence? His own gut.

    And these are the people who made fun of Bush’s own “gut feelings”. Bog posts like these make me mystanthropic as hell.

  8. Keith Bowden

    Did you miss this?

    There may be other factors, but it’s clear that people who don’t vaccinate are at least partially to blame for this.” [emphasis added]

    From your posts on BA, I think you were misanthropic to begin with.

  9. thetentman

    Luis,

    Perhaps you would be happier reading someone elses Blog. Phil just upsets you and then his followers attack your mispelled rantings and you get frustrated. Maybe you should listen to Rush and stop reading.

    cheers,

  10. Grizzly

    An infant died in Alberta last week of pertussis and the family is urging people to be vaccinated. The local CBC radio channel spoke with a virologist and it was an interesting and open exchange – on in which the topic of the anti-vaccination crowd was not mentioned.

    The virologist stated that adults need to have a booster shot to ensure that we do not transmit pertussis. Apparently our immunity wears off, and while we can get whooping cough it often does not manifest in the same ways as it does in younger individuals, for example we might not have the typical “whoop”.

    So protect your family and others by getting a booster.

  11. BT

    Someone needs to go and create a bunch of communities billed as anti-vax friendly.

    That way they’ll be easy to quarantine, and it might act a bit like a roach motel.

  12. TMB

    @4: Lower vaccination rates are absolutely a factor. It’s a non-linear phenomenon – when the average unvaccinated person is unlikely to encounter another unvaccinated person, the chance of an outbreak is low. When you reach the threshold where it is common for two unvaccinated people to encounter each other, outbreaks become much more likely.

  13. shawmutt

    Just got my Tdap booster an hour ago!

  14. Mejilan

    Painful statistics. And as is all too often the case, the next generation is forced to pay for the mistakes made by us. That an anti-vax movement is even a thing says a lot about the state of things in this country.

  15. @Grizzly

    Good point about the symptoms not necessarily being the typical “whoop” in adults. Even in kids, early on it may just seem like an average to slightly strong cold. That gives plenty of time to wander about spreading the bacteria before the whooping cough diagnosis is even considered and quarantine can be implemented.

    @BT

    I don’t think that would work all that well. Quarantine is great if symptoms are caught quickly and people actually comply with the quarantine, but people are often contagious before symptoms appear, and to make matter worse, people are notoriously resistant to adhering to a quarantine. This is especially true once you get to containing, say, a city. Just take a look a little over 100 years ago with the smallpox pandemic and how much difficulty authorities had trying to contain those outbreaks.

  16. Nick

    Thanks for posting this Phil. I’ve always been completely against the anti-vax movement, and my parents vaccinated me when I was a baby, but at your recommendation I checked the Wisconsin Immunization Record. And I was surprised to find that I am not vaccinated against pertussis.

    I’m going in on Thursday. Thanks for the great advice.

  17. Mark

    Great article Phil, as usual. One nit:

    “…who still blame vaccines on autism…”

    Should be either “who still blame autism on vaccines,” or “who still blame vaccines for autism.”

  18. Paul

    I live in Illinois, where there was a pertussis outbreak last year. I got my booster. Get yours.

  19. BT

    @Todd W.

    Yeah, probably wouldn’t work that well in practice. But a man can dream!

  20. Luis Dias

    Keith, well I’m glad that he accepts that other factors *may* be involved. If you are unable to see the hilarity there, I won’t bother ahah.

    thetentman, go away.

    TMB,

    @4: Lower vaccination rates are absolutely a factor. It’s a non-linear phenomenon – when the average unvaccinated person is unlikely to encounter another unvaccinated person, the chance of an outbreak is low. When you reach the threshold where it is common for two unvaccinated people to encounter each other, outbreaks become much more likely.

    And so the rates go up 13 times in a single year? Sorry I don’t buy it. Phil just got himself a pretty useful picture and used it for his political reasons. Don’t get me wrong, I’m all for vaccination and I really have zero patience for antivaxxers. They get me nausiated for their sheer idiocy.

    But using this statistics like as if ends justify the means… what will happen when next year the stats go back to normal? I wouldn’t be surprised if the antivaxxers would troll you with them and a smirk on their face “SEE? SEE?”. Facepalm material right here.

  21. D’oh! Autism/vaccine word placement fixed. Thanks!

  22. @Luis Dias

    If the number of cases goes down next year, it’s likely because of a combination of factors: increased uptake of the vaccine in response to the epidemic and increased (if temporary) immunity in those who were infected. Both lead to a smaller pool of susceptible people.

  23. thetentman

    Luis,

    Didn’t you’re Mom love you?

    cheers,

  24. Luis Dias

    No, thetentman, my mother did cruel cruel nasty things to me in my past. Isn’t it obvious?

  25. Loïc P.

    Will it help if we said them that in France there is a little less than 300 cases of pertussis a year for 70 millions inhabitants and that we find it is already dangerously high ?
    that we vaccinate EVERYONE for diphtheria tetanus pertussis and poliomyelitis ; for Measles mumps and rubella; ? and no adverse effect on the global population beside a few cases of allergies to the additives ? that it was vaccines that killed the smallpow in the WORLD ?
    that Rubella is declared extinct in the USA thanks to vaccines ?
    shall we lengthen the list just in case ?

  26. Aubrey Cohen

    Phil, I’d love to hear your thoughts on the vaccination statistics and discussion included in the CDC report to which the graph links.

  27. Grizzly

    Let me get personal here. I have a son who has been diagnosed as being “on the autism spectrum”.

    Of all of the stupid comments my wife and I have received over the years based on this diagnosis, the worst was the accusation that we were somehow to blame for this because we had insisted on vaccinating our children, and that the vaccination was somehow to blame for the diagnosis.

    We laughed. We laughed long and hard and when the accuser took offense we apologized and asked how this was possible.

    We listened dutifully to the screed about the evils of vaccination and then asked one simple question:

    “If this is all true, why isn’t his twin brother similarly affected, they were vaccinated at the same time with the same batch.”

    That pretty much shut the accuser up.

    The risks of childhood illnesses far outweigh any potential risks of vaccination. The benfits? The benefits are too numerous to measure.

  28. Tony

    Luis, I understand the point you’re trying to make, but come on!

    “But using this statistics like as if ends justify the means… what will happen when next year the stats go back to normal?”

    In that case OBVIOUSLY an outbreak hasn’t occurred, regardless of the idea of vaccinations. Do you see outbreaks of ebola happening around the country right now, much less around the world? As far as I know, there’s no vaccination for it, yet it isn’t breaking out all over the place.

    The lack of vaccinations does NOT imply that outbreaks automatically, immediately, spontaneously bloom. Sheesh.

    “I wouldn’t be surprised if the antivaxxers would troll you with them and a smirk on their face “SEE? SEE?”. Facepalm material right here.”

    Antivaxers are already smirking trolls, much as how you’re unfortunately portraying yourself here. Face-palm is certainly the right response, but you loaded and fired that one, yourself.

  29. TMB

    @Luis: The key thing is that most infectious diseases have intermittent outbreaks; there are years when there are far more cases than others. That’s true even if no one is vaccinated. Outbreaks require carriers to encounter potential carriers, so vaccination, which reduces the density of both, reduces the chances of an outbreak in any given year. Furthermore, as I said, it’s non-linear – herd immunity is another way of saying that potential carriers do not usually encounter each other, which dramatically lowers the chance of an outbreak.

    So, can you draw a one-to-one link between this outbreak in WA with antivaxxers? It’s a lot like blaming a bad hurricane on climate change – you can’t ascribe any one event to it, but it makes the conditions when it can occur much more likely.

  30. @BT,

    Having anti-vax communities might slow the spread of viruses a bit, but it wouldn’t stop it. Let’s say Jenny Antivax lives in Novaxville, the town right next to yours. She takes her kids (one of whom is sick with what Jenny assumes is “just a cold”) to the local Target to pick up some supplies. When she’s done, she puts her cart with the others. Two minutes after she leaves, you walk in, take the cart she was just using, and place your child in it. You’ve just exposed your child to Jenny Antivax’s kid’s germs without ever seeing Jenny.

    Skipping vaccinations should only be allowed for those with valid medical reasons (e.g. immune disorders or allergies).

  31. Craig

    Just made an appointment for a booster. Thanks for the information.

  32. @Keith Bowden,

    I agree with your “alt med” recommendation. An “alternate route” will take you to your destination the same as a standard route (perhaps just taking slightly longer). Real “alternative medicine” would be having the option of doing Treatment A or Treatment B where both actually work. If Treatment B is just sugar water that proponents claim works (because of memory or magical spells or something) when no studies have proven this is the case, then it won’t help cure the condition and it isn’t a valid alternative.

    So-called “alt med” no more “alt” than me deciding that I’ll drive from New York City to California by continually heading south in my car. That route will never take me anywhere near California and “alt med” will never get me anywhere near cured.

  33. Working in ERs and Critical Care Transport in the most affected county in WA I have seen I think three of these cases, one was sick enough that his little life was in danger. Having stupid parents is a pretty crappy reason for a baby to die, but it does happen.

  34. Paul

    How about we sequence the genome of pathogens in infected individuals, and use that information to trace the pattern of transmission? That way, if someone is unvaccinated but infects others, they can be held legally liable. Their victims could sue for damages, particularly in case of infant deaths.

  35. DrEnter

    I am 100% with you on vaccinating children, Phil. I get my son all the recommended shots (much to his chagrin), as well as some extras (to his greater despair) as we travel internationally. One thing worth noting: The pertussis vaccine wears off. If you are an adult, you should get a “TDaP” (the adult version of the childhood “DTaP”, or Diphtheria, Tetanus, and Pertussis) the next time you need a Tetanus shot. You only need one TDaP between age 20 and 64, then again after 65, but I wouldn’t miss out on it: Adults get Pertussis, too. Note that there is no hurry, as it’s just a booster, so just wait until you need your next Tetanus shot.

  36. @DrEnter

    Well, given that we are seeing more evidence that efficacy may not last as long as we previously thought, and that there is currently a pandemic, I’d say talk to your doctor if you have not had a pertussis booster within the last 5 years or so. IIRC, that is what CDC is recommending.

    Also of note, even if you have had pertussis before, immunity is not lifelong and, like the vaccine, can wear off. So it’s worth getting a booster even if you’ve had pertussis before.

  37. Brenna

    What percentage of the confirmed whooping cough cases have occurred in those who have been vaccinated?

  38. See the link above for the full MMWR article.
    “On December 13, 2011, the Minnesota Department of Health was notified of varicella in a girl, aged 3 years, admitted to a hospital after a 2-day history of fever of 102.7°F (39.3°C) and an extensive maculopapulovesicular rash (>500 skin lesions) with vesicles in the mouth and throat. The child received weekly immunosuppressive therapy with methotrexate (12.5 mg) for juvenile rheumatoid arthritis diagnosed at age 18 months. Neither she nor her younger sibling, aged 21 months, had received a first dose of varicella vaccine (routinely recommended at age 12–15 months). Their parents refused vaccination because of personal beliefs. The parents reported varicella in the younger sibling 2 weeks before her older sister was admitted. The older sister had not received prophylactic varicella zoster immune globulin (VariZIG); however, her parents monitored her for varicella symptoms. ”

    As far as I am concerned, the parents should be arrested for child endangerment and never regain custody of their children again! For the two year old, there is an excuse to not vaccinate. There was and is less than no excuse for the healthy child to not be vaccinated!

    We had a bit of a “scare” last week. It seems that Pennsylvania has a bit of an outbreak of pertussis. Our daughter was informed by a friend that her children were exposed to another child who has pertussis.
    As my wife had taken the call, the information wasn’t complete at all, so I called our daughter to gain more information, literally checking my epi info software was still operable as well.
    Fortunately, my daughter’s friend and her children all had their vaccines up to date, as did my daughter and our granddaughter. The only concern was possible spread of contamination between the ill child to our brand new grandson (born July 3, so no DTP yet).
    As the friend sanitized the playset and toys and my daughter, being an RN, is nearly obsessive in sanitation and hand cleansing, the risk was negligible. Especially as she’s nursing the baby, hence passing antibodies along.
    But, that ill child’s parents neglect makes my blood boil!
    As far as I am concerned, the HHS should enact a mandatory quarantine of every unvaccinated person when there is an outbreak of a preventable disease.

  39. ND

    I got a TDaP booster recently after asking my doctor what sort of vaccination I need currently.

  40. Robbie

    Interesting, but what does this have to do with astronomy?

  41. LoriKP

    I am a public health professional in WA state. While vaccine refusers are surely part of the problem, that alone does not fully explain the current epidemic. Waning immunity is another factor, and most cases are being transmitted by school-aged children and adults, many of whom were previously vaccinated but now have mild cases of disease due to waning immunity.

    This epidemic highlights the need for adults to receive booster shots and for older children to follow the recommended vaccination schedule. And, I suspect, it will ultimately result in changes to how often older children need boosters. Figure 2 of the MMWR report (July 20, 2012 / 61(28);517-522) is just as startling to me as Figure 1. It clearly shows that immunity wanes much sooner than we’d like. Look at the incidence spike at age 10 and again at ages 13-14. (also look at the incidence for children under 1 year of age – it’s unacceptable)

    To Brenna, most cases are occurring among the vaccinated, but this is not unusual. First, no vaccine is 100% effective. Second, even though we have high rates of vaccine refusal here, we still have 70% or more of people who do vaccinate so it’s simply a larger pool of people relative to the unvaccinated. Once pertussis (or any infection) gets a foothold in a community and finds enough of a reservoir, the disease will spread to some percentage of the vaccinated. What I think would be very interesting would be to look at attack rates by vaccination status, but that is difficult to do. First, you’d have to know how many people in the state/county are truly unvaccinated, determine how many are infected, and then compare the rate to that among the vaccinated. I have not yet seen such an analysis for WA this year.

    Nonetheless, here’s the bottom line – infants are at highest risk for fatal outcomes from pertussis, and we don’t start vaccinating until 2 months of age. With herd immunity breaking down due to vaccine refusers and waning immunity among some of the vaccinated, we are allowing pertussis to find enough reservoirs in our community to put babies at significant risk. Even if you don’t come into contact with babies, you come into contact with other people who might. You could come down with a mild infection that is never diagnosed, and you won’t even know who you’ve transmitted pertussis to. Check your vaccination status for yourself and your kids and get whatever booster you need. Vaccines are still our best tool against pertussis. No baby needs to die or be hospitalized due to pertussis today, but we need our neighbors to all do their part.

  42. Michael

    When will the government put Jenny McCarthy and the other anti vaxxers in prison for impersonating Doctors and Scientists? Those idiots need to be put in solitary confinement with no outside communication, for child endangerment!
    These outbreaks can be traced to the unvaccinated, disease carrying, unhealthy illegal aliens that we keep letting cross our borders. They make us sick. They tax our social services. They tax our health care system. Now our wise government is telling them they are welcome to stay!
    I also blame the people that listen to “celebrities” , and do what those idiots tell them to do, or not to do.

  43. Wzrd1

    @LoriKP, wouldn’t a database record of vaccinations by county be of worth? Names need not be recorded, only unique indentifiers to prevent duplicate records.
    Then, it would be a matter of looking at population numbers vs vaccination date or lack of vaccinations per individual.

    @Michael, #43, your claim of illegal aliens bringing preventable, communicable diseases into the nation has zero data to support it. Zero. Zilch. Nada. None.
    Indeed, you ignore the benefit in your claim of “tax our social services”, as the least desired, indeed, REFUSED labor is performed by them. Or are YOU volunteering you and your family to pick fruit and vegetables, do garden work, prune overgrown trees from utility easements, all for or under minimum wage?
    And your claim that “our wise government is telling them they are welcome to stay” falls flat, as INS is still deporting illegal aliens every day of the week. Daily. THAT is easily found by a three second search. But, I guess you’ll then claim that the INS reports false numbers of deportations.
    However, I DO agree with you in some part. Parents who refuse to vaccinate their children SHOULD be held accountable for harming the child, however I insist we follow our constitution. We’re not a fascist nation, we defeated fascist nations, so why should we become what we destroyed?
    People SHOULD cease following ill informed “advice” from “celebrities, however, people have followed celebrities since the very first celebrity, so I hold zero hope that humans will suddenly evolve enough to use their brains.
    As you’ve quite well proved by your regurgitation of nonsense against illegal aliens, zero evidence, only wild claims. Claims that are very nearly verbatim against different legal immigrant groups, claims that are well over a century old and all quite well disproved.

    BTW, it’s not illegal to impersonate a scientist. Indeed, it’s not illegal to impersonate a physician. It’s only illegal to practice medicine without a license. Try learning about the laws of your land, you’ll make it stronger by being knowledgeable, rather than weaker through continued ignorance.

  44. @43 Michael – You should read a little before you type. In Mexico they require vaccinations of everyone, no exceptions for new age hippie freaks. They are the problem, not immigrants.

  45. jearley

    Vince- it is not just Hippies, many of whom are strong supporters of science. You also need to include the right wing nuts who think that since the government wants them to get vaccinated, there must be some sort of plot. So they won’t get vaccinated.
    In an odd coincidence, AZ public media reported today that the rate of Pertussis in AZ had tripled. I tried to find the story on line, and could not, so the source is perhaps suspect.

  46. Shoobs

    Whoaaaa correlation-causation. I would really like a little more data the outbreak, ages and rates of vaccination especially given the argument being made here. A localized drug and vaccine-resistant outbreak might be just that. In which case, why exactly would it be super important to shoot up your kids with a vaccine that doesn’t work?

    I may be super misinformed here but I was under the impression that whooping cough was way deadly in infants so the 2500 incidences in washington vs 8 infant deaths in the US actually seemed small and leads me to believe the bulk of cases are probably in adults who were probably vaccinated before everyone got up in arms about it anyway. I actually think whooping cough is probably a worthwhile vaccine I’m just not fond of this article.

    Also sticking the data about the incidence jump in washington and washington’s incidence being 9 times the national average together is misleading. I would guess the latter has more to do with washington being a cool, wet paradise for respiritory conditions than the recent politics regarding vaccines.

  47. HP

    My favorite blog post on childhood immunization is by Jim MacDonald (SF author/EMT) over at Making Light a few years ago:

    http://nielsenhayden.com/makinglight/archives/010978.html

    It’s about the symptoms and morbidity rates of preventable childhood disease, illustrated with epitaphs from 19th c. tombstones.

    We tend to think of childhood viral diseases as some kind of “rite of passage.” They’re not. Even with the best palliative care available in the early 21st century, pertussis kills. Measles kills. Diphtheria kills.

    There are parents out there who won’t let their kids wander down to the creek by themselves to look for crawdads and play pirates because of irrational fears about stranger abductions, but who willingly expose their children to provably fatal preventable disease.

  48. LoriKP

    had to edit, see post below.

  49. LoriKP

    Wzrd1, it’s a good thought, but each state has its own law for what is reported for public health purposes. WA does not collect vaccination information on an individual basis; we require schools and daycares to report aggregate numbers based on parent reports of whether or not their children have been vaccinated. There is no reporting for adults (that I know of).

    Even if there were a database to capture vaccinations among all residents, it would still be problematic due to our mobile population. The pertussis booster is given to adults every 10 years. How would you know in your database whether relatively new residents got their boosters in other states or not? You wouldn’t.

    Currently, the best types of databases often come from insurance companies. They have vaccination records for their members because they pay the provider for the service based on codes that can be traced. This is why epidemiological studies in the US often come from population subsets, like Medicare populations or the privately insured. Of course, the problems there are always whether the results are generalizable to other populations or not. Data from a Medicare database, which includes only people 65 and older, might differ from the population as a whole in important ways, for example.

    I still dream of a day when this country will have single-payer health care, not just to cover all our citizens, but to provide opportunities for robust epidemiological research. The best epi work comes from other countries with “socialized” medicine because they have the infrastructure to capture data on their entire population. This is an overlooked but very important argument for health care reform in the US. Until then, we continue to be hamstrung when trying to do certain epidemiological work.

  50. Stephen

    Worth noting is that waning immunity to pertussis is a characteristic seen with natural disease. It is not like we have traded life-long immunity for a vaccine. A review of the published data reveals estimates that infection-acquired immunity against pertussis disease wanes after 4-20 years and protective immunity after vaccination wanes after 4-12 years. [Pediatr Infect Dis J. 2005 May;24(5 Suppl):S58-61.Duration of immunity against pertussis after natural infection or vaccination.] Cases of pertussis occurred among teens and adults in the era prior to immunization, so nothing is new here. In the days before adult reimmunization was available, I remember an index case in a school bus driver resulting in a fatal case of pertussis in an infant (sorry for the lack of additional details, but it was many years ago).

  51. Wzrd1

    @LoriKP, I know each state has its own laws. I was suggesting something you could suggest for your legislature. I also suggest that the parents word on immunization not be accepted, but as our state has done, require documentation from their medical professional as to the immunization status of the student. Professionals tend to not wish to falsify documentation, whereas the lay can occasionally, for personal reasons (religion, political motivation, misinformed, etc) more frequently do falsify documentation, such as immunization information of their minor children.
    That said, without state legislation requiring immunization information of the TOTAL populace, there will be the same story. Zero reliable information to assess a potential epidemic. Various state and federal laws tend to shield the information if there are no local laws requiring non-PII sharing of immunization records (hence, my suggestion of unique records that hold no PII, only being unique per person). Your Medicare information is an excellent example, as it is trivially made anonymous, but can still provide valid information as to many medical status issues of the patrons, which help provide targeted enhancement of services.

    I also agree. I’ve personally witnessed a substantial number of nations who have “socialized medicine”, the US tends to be, quite LITERALLY, behind said nations in technology of health care. One case in point is on trial here in the US, however, it’s been common for nearly 20 years throughout Europe: percutaneous coronary valve replacement. Chronic pain research is lacking in the US, but is a target of interest in both Germany and Japan.
    Of course, that reflects US history of medicine overall, throughout our nation’s history… :/

    @Stephen, any health care professional will NEVER argue that the disease or the immunization will provide superior immunity to any disease. EITHER will fade at pretty much the same rate, save for a few vaccines (such as smallpox, where similar is not the same and some other ill understood issues). However, immunization means no illness with the newly acquired immunity. Experiencing the disease can easily result in no issue, chronic disability, morbidity or mortality. Mortality is the biggie, as we’ve YET to figure out how to work around being dead for a patient.
    For myself and my family, we universally choose immunization. It’s the lesser risk of the scenarios. We even considered smallpox vaccination, as I recently retired from the military and said vaccination was available to us. However, the extinction of smallpox “in the wild” and lower safety of vaccinia and the risk of progressive vaccinia lead us to consider vaccination against smallpox as unnecessary and of excessive risk (I personally had a minor, resolved case of progressive vaccinia as an infant, which rather dates my age by a bit).
    I’m uncertain if your comment was pointing toward lapsing immunity and the necessity of boosters or of other nature.
    However, this discussion caused me to look at my copy of my medical records. I noticed, I need pretty much every immunization now, save Hep B, which is still current and antibodies titered, due to an issue with immunization series being interrupted by mobilization three times.

  52. VinceRN

    @46 jearley – The far right has it’s own problems, mainly the religious nuts who are just as dangerous in their own way. However, every single anti-vax person I have ever met has been of the new age hippie wacko persuasion. I have never met a single person that that avoided vaccinations because they were conservative and thought it was a conspiracy. The extremes of both political persuasions are dangerous, and neither has much use for science, but the wing-nut fringe of the left owns this particular problem. I have met a few that don’t vaccinate because they think God wants them to avoid medicine altogether, but that is not the same as a conspiracy nut and not all people that acoid medicine because of religion are politically conservative.

    To put my comments on this in perspective, I have worked ER for 22 years now and have been talked to many thousands of people about their kids vaccinations in that time and done quite a lot of teaching on the subject and used to argue with people about it until I wised up and realized that trying to teach a bear to sing just wastes my time and annoys the bear.

    Since they started using it I have given hundreds of TDaP/DTaP/DPT shot to people of all ages. It hasn;;t been used routinely for tetanus boosters for all that long though.

    Also, as a home schooling family we are of course acquainted with a lot of other home schooling families and so see a lot of wackos from both extremes. Only the ones form the extreme hippie new age wacko side are anti-vax.

    That doesn’t mean the there are not many hippies that support science, there are. There are also many red necks that support science. I have known scientists and engineers of both persuasions.

    I say only that the vast majority of anti-vax people are far left hippies new age wackos. There certainly must be far right wing nuts that are anti-vax, but my experience indicates that their number is trivial. I do not by this mean to attack your political beliefs, nor to defend someone else’s, I only try to neutrally state cold facts.

  53. VinceRN

    @48 HP – We have had vastly more stranger abductions of kids that deaths of kids form pertussis and the rest of those diseases in recent times in Washington. While that chance of a stranger abduction is very low, is is vastly higher that the chance of dying of one of those diseases.

    It probably would not be so if we had no immunizations, but since we do, end since even here in Washington most do immunize, it is.

  54. Chris2

    Brenna:

    What percentage of the confirmed whooping cough cases have occurred in those who have been vaccinated?

    Perhaps the question should be: How many had their vaccination too long ago? Though it you look at hte stats, it seems that many were middle school kids who were last vaccinated when they were four or five years old. Which is plenty of time for the immunity to wear off, even if they had had the actual disease.

    Robbie:

    Interesting, but what does this have to do with astronomy?

    It has to do with not understanding real science, which what Dr. Plait is ultimately interested in. If you don’t like the subject, then don’t read the article.

    Shoobs:

    Whoaaaa correlation-causation. I would really like a little more data the outbreak, ages and rates of vaccination especially given the argument being made here.

    Here is the information from the Washington State Health Department, if you want more information that does not violate HIPAA, contact them yourself:
    http://www.doh.wa.gov/Portals/1/Documents/Pubs/348-254-PertussisUpdate.pdf

    What is going on in Skagit and Whatcom Counties? Though it looks nasty when you just look at the rate per hundred thousand of population. The second largest raw number is King County, but the rate is lower because its population is more than twice than any other county (a bit over a quarter of the whole state) . And yet the largest raw number is still Skagit County, with less than one tenth of the population of King County!

  55. Infinite123Lifer

    For VinceRN:

    I will tell you . . . I do not know who convinced me that vaccines were bad but somebody did . . . for a minute . . . awhile ago. Yeah, I know billions of lives have been saved due to vaccinations, I knew it when people brainwashed me to believe that they were still bad. I don’t know that I will ever feel good about being immunized or having my children immunized but I know that I am not the authority on the matter. No matter how much reading I do. And living in WA and having a father who develops deadly pleurisy on average once a year and worrying about him and newborns around our family . . . facepalm. I just do it. Because I think its the right thing to do based on what I know about it. But when I do get shots I make sure I don’t go anywhere around my father till I know I am not sick. I suppose I do this as just a better safe than sorry policy due to the fact that I have known people to get flu shots and get the flu . . . now I have no idea whether they contacted it from the shot or it was just coincidence ( I think it was coincidence) but thats just it . . . there is something about the hippie that is appealing to me. Naturalness maybe. Yeah, I guess death from malaria is natural. It is all quite relative in time with hindsight and sometimes sadly so.

    Its like nobody can agree on anything. I swear you could ask the entire world if they were alive and there would inevitably be a 1% saying “no”. And inevitably as well I am probably part of some 1% group somewhere in philosophy-land. I suppose the notion that “the world cant even agree on one simple thing” is a major factor in what drives our creativity and even our imaginations . . . aspects of human nature which are seemingly boundless…someones always thinking differently . . . albeit for our greatness in Life or to our lasting misery.

    I think its an interesting question to ponder if the future will become more simple or less simple. I can see misery arising like a plague and yet I put my hope in our capacity for greatness. If greatness were to factor into the future (which it must) exponentially, (fingers crossed) the world might become a simpler more friendly place where maybe large portions of people can unanimously agree on simple Life saving human endeavors.

    btw: do they got a vaccine yet for weirdo strangers that doesn’t require bullets? ;)

  56. Freddie

    So, it only kills infants, and furthermore it only kills the infants of people who think that vaccinations are a: offending their god (somehow) or b: a plot by the government to kill their kids. So the disease is in fact culling the children of stupid people. What’s the downside?

  57. Satan Claws

    This is disturbing. Should we expect a growth in the number of reported cases on other states as well, simply because people move around and unknowingly carry the bacterium with them?

  58. roman

    It is a very interesting debate what flavour if irrationality is more prone to spread anti-vax toxic thought.

    I am Spaniard and living in Barcelona. Here the anti-vax crap is being spread by a certain kind of middle class people. The underlying ideology has some characteristic threads that are difficult to classify as right or left. They are people fiercely individualistic who think that their own thinking is the only relevant. They despise government agencies and consider them as tools of the pharmacy industry. So they speak as leftist but the egocentric individualism and the hostility towards State that they display relates more with a kind libertarianism understood as a come back to nature. I guess most of them vote right wing parties with anti-taxes programmes.

    Of course we have UFO weirdos and New Age wackos opposing vaccination but they are not so dangerous as the middle class integrated mainstream people.

    And to finish the analysis, in Spain the religious people have lots of problems with sex and same sex marriages and abortion and religion not being taught in school, etc… but so far not any with vaccination.

  59. jearley

    Vince,
    Thank you for the input. I work in an area with the highest percentage of unvaccinated perople in the US- Southern Oregon. Lots of new agers, and yes, some (many?) of them, including a few friends of mine, refuse to vaccinate their kids. One of them is a teacher at the school that I work at. He has 5 kids, including an infant. I warned him and then shut up. He is NOT a new ager- other end of the spectrum.
    As roman seems to indicate in his post, perhaps there is a regional variation in social/political/religious affiliations who subscribe to the anti vax view. If it was just adults, I would let Darwin take its course, but the kids do not have choice. I am hoping the the new Oregon law providing penalties for withholding medical care from children can be used to prosecute parent whose children are harmed by this. To me, it is a form of child neglect, but if an infant died, then it is manslaughter, and should be punished as such.

  60. Ceryle

    Here in Aus, all kids are given a health record when born. As they are vaccinated (which is all free), then their record is updated by the doctor (which not only has his signature, but the exact vaccine, its batch number and use-by date so that all this data is available if needed). This information is also automatically sent to Medicare, so that we have up-to-date records for all of these statistics (Medicare is our government-run health system, which provides the money for all our free health care). Child-care centres, pre-schools and schools all need to see the vaccination records before you can enrol. You can get a letter re conscientious objection, but you need to have an interview with your doctor before they will give you this. Many child-care centres will not admit a child who is not vaccinated / has a letter of objection.
    On a more personal note, I am pregnant, so can’t get a booster for pertussis at the moment, but our family is all getting them, as my mother-in-law had whooping cough last year, but wasn’t diagnosed until about half-way through the “100-day cough”. Given the fact that my father-in-law was immunocompromised at the time, she kept going back to her doctor re the cough, too.

  61. Nigel Depledge

    Thetentman (9) said:

    Maybe you should listen to Rush and stop reading.

    Yay, Rush!

    Hmmmm . . . was Moving Pictures their best album?

  62. Nigel Depledge

    Robbie (41) said:

    Interesting, but what does this have to do with astronomy?

    Nothing.

    Did you have a point?

  63. “I hate to even say this, but when will the government step in and stop this insanity?” When the libertarians (in all parties) stop saying that it interferes with parents’ rights.

  64. Robbie

    @Nigel Depledge – Did I have a point? Not really, just asking a question. I stumbled upon Bad Astronomy while searching astronomy related blogs. This post just seemed a little out of place and I wondered if there was some sort of cosmological link I was missing. Apparently not.

    @Chris2 – You said, “If you don’t like the subject, then don’t read the article.” Where in my post did I say (or even hint) that I didn’t like the article? In fact, I said it was “interesting”. I was just curious as to why it was posted here. But now that I know this blog is just a place for people to bash other people who don’t “understand real science”, I’ll say goodbye and find myself another blog to follow that actually deals with astronomy (and where people are a little nicer).

  65. @Robbie

    It’s not a place to bash people for not understanding real science. If you feel the comments are on the harsh side, don’t read them. Phil posts plenty of astronomy related articles, but occasionally he ventures into other science- and critical thinking-related topics, vaccine refusal being one of them. When he strays off of astronomy, inevitably there is someone who asks “What does this have to do with astronomy?”, the implication being that Phil shouldn’t write about it. Hence, the types of reactions you got based on the regulars’ past experiences. You should really stick around, though. If you leave because of the tone of comments, then you’re missing out on a lot of good stuff.

    @Freddie

    So, it only kills infants, and furthermore it only kills the infants of people who think that vaccinations are a: offending their god (somehow) or b: a plot by the government to kill their kids. So the disease is in fact culling the children of stupid people. What’s the downside?

    The down side is that it is not so selective. The majority of deaths are in children who are still too young to receive the vaccine, regardless of their parents’ views. And even if their parents refuse the vaccine, the children shouldn’t be the ones to suffer from that shortsightedness. For example, take the McCafferys who lost their daughter, Dana, to pertussis. They would gladly have immunized her, but they never got the chance. An outbreak in their area of Australia ended up making its way to Dana, killing her when she was just four months old. Phil has written about them several times, if you’d like to know more about their story. Also, you can go to danamccaffery.com.

  66. mike burkhart

    If this is on the rise how about the rates for polio that criples for life? President Franklin D Rosefelt sufured form this.Now as for people who don’t understand Science: I have found it’s largely the attiude of the person toward Science thats the problem while people like me and everyone on this blog are facinated and love science and some like Phil have dedicated there lives to it ,some see Science as something geeks and nerds do. Some think it not important in there lives and wonder why explore the Universe and a few religous fundamentelists see Science as a conspricy to destory Religon( a view held by few this Catholic and Amuture Astronomer thinks Religon snd Science can peacefully coexist) I think we need to change these attiudes.

  67. @John Wilkins

    The Refusers are such a joke. It really is hard to tell whether they are that clueless or are just pulling an incredibly elaborate Poe.

  68. @Robbie:
    You’re new here, aren’t you?

    Just got my TDap at my physical last week.

  69. @68 John Wilkins: Wow. WOW. That is one of the most disturbing things I have ever seen. Not just a band devoted to spreading vaccine denial, but one that has an 11 year old boy as a member. That poor kid is going to feel horrible some day when he figures out how he was used to help push harmful falsehoods.

  70. Autistic Lurker

    Last year, I actually asked my primary care doctor to give me the dtap vaccine because I have a few antivaxxer for friends and now, the antivaxxers are getting whooping cough so it’s comming back in canucksland.

    This year, I’ll make sure to insist for the vaccine booster again.

    A.L.

  71. realta fuar

    @roman In the U.S. the people you describe are generally “Libertarians” and their basic philosophy comes from the nut-case, drug addicted, Russian emigre to the states, Ayn Rand. These folks can generally be distinguished by the fact that they think they’re smarter than everyone and know more about any particular subject than anyone else, regardless of whether a person has spent their life actually, you know, STUDYING that subject. When they vote, it’s generally Republican if there’s only a choice between them and Democrats but they do have their own party. Their political philosophy can basically be summarized as “I’ve got mine and I don’t give a s*** about whether anyone else gets theirs”.

  72. RobT

    @Wzrd1 – 12.5mg of methotrexate? Poor kid. I am on 25mg injection once a week and it makes me feel nauseous the day after injection. I can’t imagine how that makes a small child feel. But in my case, there are 2 reasons for my taking it and the side effects are much better than the alternative. However, I don’t understand the parents’ objections to vaccinations but not to methotrexate. Methotrexate has more, and more severe, side effects than vaccinations.

    Parents need to be told that their children’s life may depend on whether they are vaccinated; it may very well depend on it.

    Also, isn’t vaccination required for children to attend school? I know it was when I was yoinger and they came around to my elementary school to administer the booster shots.

  73. @RobT

    Yes, vaccinations are required for school, but most states allow for religious and/or personal belief/philosophical exemptions (only two states restrict exemptions to medical reasons only).

  74. The UK, where the current anti-vaccine pseudoscience started with Andy Wakefield, is experiencing a similar epidemic of whooping cough. Six infants have died this year.

    I have just about had it with the anti-vaxxers. I know I have had it with Wakefield.

  75. brittany

    acellular pertussis vax does help clear pertussis, but caused a 40-fold increase in parapetussis CFU’s in the study rats.

    http://rspb.royalsocietypublishing.org/content/early/2010/02/26/rspb.2010.0010.abstract

    The aP vaccines are comprised solely of pertussis antigens that are are NOT EFFECTIVE against parapertussis. The study I posted shows that vaccination with aP resulted in a 40-fold increase of parapertussis CFUs, and furthermore IMPEDED immunity to parapertussis, measured as reduced lung inflammatory and neutrophil responses.

    I find this theory for the increase in cases interesting, considering doctors, to the best of my knowledge, do not differentiate in their diagnosis between the two.

  76. Chris2

    brittany, saying that the pertussis vaccine does not work for parapetussis is like saying there is something wrong with the MMR vaccine for not working for fifth disease. It does not make sense.

  77. McKay

    I’m vaccinated. Let’s just get one thing clear. Whether you vaccinate or do not, you are always capable of carrying the germs that cause these diseases. A vaccine produces an antibody response in an individual body, meaning that if it is attacked by a particular germ, the conditioned response is suppose to prevent the individual from getting sick. It does not keep their body germ free and incapable of passing potential disease along. Both the vaccinated and unvaccinated can do this. The germs don’t cause actual sickness until a person is infected….hence wanting your body to be able to fight off the disease. This is why cleanliness and hand washing is so important. That is what “rinses” germs off and keeps them from being passed along. The vaccine cannot not prevent this.

    That all being said, blaming the rise in pertussis outbreaks on the unvaccinated population and not the vaccinated is bad science. Unfortunately, we’re all potential carriers. Whatever your decision, you’re definitely causing problems if you never wash your hands or keep up your personal hygiene. The truth of how a virus spreads is very important. Most vaccinated people think that because we’ve had the shots that we’re not going to spread the disease around. This couldn’t be further from the truth. You still have a daily personal responsibility in being clean, and many people are too cavalier with this because they think a vaccine keeps them from spreading sickness.

    For example, even if someone is fully up to date with their vaccines, I absolutely do not want them touching my baby if they’ve just come out of a bathroom (esp. a public one, and we all see people use them and then not wash their hands) without washing up afterward. That is dangerous. Even though they’re vaccinated it’s dangerous because a vaccine does not make us exempt from germs.

    This has been redundant, but I cannot stress enough: preventing illness does not rest on the vaccines alone. And because there will always be that person who the vaccine does not work for or the individual who for medical reasons cannot be vaccinated, the vaccinated population needs to be aware of this because we could be spreading the germs around and completely clueless about it.

  78. Chris2

    McCay, first pertussis is a bacterial infection not a viral infection. Please understand there is a difference?

    And how is a vaccinated person able to infect others when the vaccine does not contain the entire bacteria, but just portions?

  79. Chris2

    While I was watering some very parched porch plants when I remembered this explanation:
    http://justthevax.blogspot.com/2012/08/100-certainty.html

    And I apologize for misspelling your name, McKay.

    And by the way, next time provide some actual references. The only diseases I know that can be spread by a vaccinated person is vaccinia (the diseases is a descendent of cowpox, and only military personnel get it to protect them from smallpox), and OPV, oral polio vaccine, through a person’s fecal output.

    So, really, provide some actual references and remember there is a difference between viruses and bacteria. One really cool way to learn about them, including the fact there are viruses (phages) that infect bacteria are the three podcasts that are linked to on the right side of the following site:
    http://www.virology.ws/

  80. Marianne

    Chris2 – I believe McKay was not saying that getting the vaccine causes you to be infectious, but rather that whether or not you are vaccinated, you can spread germs through poor hygiene practices.

  81. Jamie

    This article is just attributing to the propaganda of the “antivaxers”. First of all, “antivaxers” do get vaccines. They just get them on a different schedule and instead of overloading their infants with multiple vaccines in one single shot, they spread them out to make sure there is no reaction to the individual ingredients.
    Second of all, if you look at this info from the CDC http://www.cdc.gov/pertussis/outbreaks.html, Washington is not the worst state for this outbreak. So, why do people keep focusing on WA? And if the problem was really the “antivaxers” California would have been top of the charts-but guess what, CA shows no change or a decrease.
    Third of all, even though there is an outbreak the numbers are still not that high when compared to 2004-2005 and there was no mass hysteria about it then.
    Fourthly, I lived in AZ for the last three year and there were these commercials for “the dangers of Pertussis” and about how you need to get your vaccine. I think it is real “funny” that those commercials went on for 3 years during a time when there wasn’t an outbreak and now all of a sudden there is “the worst outbreak in years”. Seriously, those commercials were on every damn break. And all my years of living in GA I never saw a single one.. interesting..
    Don’t buy into the hype. It’s all about making money. And the vaccine industry is incredibly evil when it comes to doing what makes them the most money vs doing what is best for you. They are in control of most of the protocols that tell doctors how to treat their patients. I have worked in hospitals for years and one thing I can tell you is that the health care industry is just that, an industry. It’s main goal is to make money. Period. It is not healthy and does not have your best health interests at heart. It is up to you o figure out what is best for your family.
    Do your own research before you let people scare you. http://www.cdc.gov/pertussis/outbreaks.html

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